Question: I have had mastoiditis for more than 6 weeks. I have had 5 short-term rounds of antibiotics including amoxicillin (10 days), a Zithromycin Z-Pack, Rocephin by IM injection and vein (one dose in the injection and one dose in an IV, Augmentin (10 days) and another round of Amoxicillin (currently on 6th day, 500 mg. TID). I am 64 years old. I cannot remember having otitis media or otitis externa at any time. My first symptom was pain behind the right ear. I thought, since is a muscle insertion on the mastoid process, that I had sprained the attachments of the muscle. I used anti-inflammatories (ibuprofen) and warm compresses, but when my symtomology did not improve and I developed fever, I consulted with my PCP. He diagnosed acute mastoiditis and that's when all of these "rounds" of antibiotics began. Each time, as soon as I finish the round of antibiotics, the infection returns. I have experienced severe nausea and poor balance. My PCP is not able to resolve this infection but I don't want to insult him by suggesting a longer course of antibiotics, as recommended by my pharmacist. I am at a loss as to what to do. I have been sick for 6 weeks...it's really not good for me, at all. My balance was so poor that I fell on my foot and actually fractured my 5th metatarsal and I'm now in a cast! What do I do? I am in a managed care HMO and the wheels of managed care turn very slowly.
I only have 3 more days of amoxicillin available and I know, as soon as I stop taking it, the "smoldering" issue will return. I have not had a CT or MRI to learn more about the mastoiditis and it's severity.

Thank you. Now...how do I get my PCP, whom I really like, to refer me...seems reluctant. I don't want to insult him.

What is the best antibiotic for this type of infection? I understand it is usually pneumococcal. What is the best way for this antibiotic to be delivered??? Orally, IV, or IM? (or PIC line?)