Bilateral mastoid subperiosteal abscesses in an infant

A 9-month-old boy was brought to his primary care physician for evaluation of bilateral purulent otorrhea following an upper respiratory infection. The patient was started on azithromycin. When he did not improve, he was switched to cefdinir. Cultures taken by his pediatrician prior to the initiation of antibiotic therapy grew Streptococcus pneumoniae.