Acute suppurative mastoiditis usually evolves following several weeks of inadequately treated acute otitis media It is characterized by postauricular pain and erythema accompanied by a spiking fever CT scan reveals coales- cence of the mastoid air cells due to destruction of their bony septa Initial treatment consists of intravenous antibiotics (eg, cefazolin 0 5–1 5 g every 6–8 hours) directed against the most common offending organisms (S pneumoniae, H influenzae, and S pyogenes), and myringotomy for culture and drainage Failure of medical therapy indicates the need for surgical drainage (mastoidectomy)