High variability occurs in the treatment of children with acute mastoiditis, according to findings published in the American Journal of Otolaryngology. Stephen Edwards, MD, and colleagues examined acute mastoiditis in a retrospective observational study of children (>6 months to ≤18 years) admitted to a single center during 2011-2019. Through EMR data, the researchers identified 129 patients (63% males; median age, 6.4). Ear protrusion was associated with lower odds of acute mastoiditis with intracranial extension (OR, 0.307; 95% CI, 0.107-0.883), while headaches and/or neck pain increased the odds of acute mastoiditis with intracranial extension (OR, 3.96; 95% CI, 1.29-12.1). The most frequent etiologies were Streptococcus pyogenes (19.2%), Pseudomonas aeruginosa (17%), and Streptococcus pneumoniae (12.5%). Empiric antibiotic choice and length of therapy were highly variable. The empiric antibiotic used most often was IV vancomycin with a third-generation cephalosporin (34.8%), and most patients (73%) completed the course with an oral antibiotic.