10 Acute Otitis Media Steinberg Flashcards
What is Acute Otitis Media (AOM)?
Infection of the middle ear with acute onset and S/Sx, MEE, and acute S/Sx of middle ear inflammation
What is Otitis Media with Effusion (OME)?
Presence of middle ear effusion (MEE) without signs and symptoms of infection
What is Treatment-Failure AOM?
Lack of improvement in S/Sx within 48-72hrs after initiation of antibiotic therapy
What is Recurrent AOM?
3 or more AOM episodes in the previous 6 months or four or more AOM episodes in the preceding 12 months
What is Difficult-To-Treat AOM?
Includes both recurrent AOM and treatment-failure AOM (affects up to 20% of children who develop AOM in their first postnatal years)
What is Chronic OME?
OME for 3 or more months duration (chronic serous otitis)
What is Chronic Suppurative Otitis Media (CSOM)?
Is a perforated tympanic membrane with persistent purulent drainage from the middle ear
What are the characteristics of a “Normal” Tympanic membrane in children?
Translucent/transparent. Gray or pink color. Neutral position. Fully mobile with pneumatic otoscopy. No effusion
What are the characteristics of an AOM Tympanic membrane?
Opaque. Red, yellow, or cloudy. Bulging or full position. Reduced mobility with pneumatic otoscopy. Effusion present
What is the Otoscopic diagnosis of otitis media like?
Purulent Otorrhea of < 24 hours. OR. 2 of 4 TM abnormalities (MEE): Impaired or absent mobility, Yellow/white discoloration, Opacification (other than from scarring), Air-fluid interfaces. WITH. 1 indicator of inflammation: New ear pain (+/- unaccustomed ear pulling), Marked TM redness, Bulging TM; loss of anatomic landmarks
What is Tympanocentesis?
Trans-tympanic needle aspiration of ME contents; decreases ME pressure and very effective in relieving pain; culture and sensitivity is performed on the aspirate
What virus is AOM strongly correlated with?
RSV, HMNV
Which viruses are most commonly associated with otitis media?
Streptococcus pneumoniae. Haemophilus influenzae. Moraxella catarrhalis
Which virus is most often associated with a Fever in AOM?
S. pneumoniae
What is the primary antibiotic used in AOM?
Amoxicillin
For ages 6mo to 2yo when can just just observe AOM?
Unilateral AOM without Otorrhea
For ages > 2yo when can you just observe AOM?
Bilateral or Unilateral AOM without Otorrhea
Why can observation of AOM be good?
Provides an opportunity for shared decision making with the child’s family. If observation is offered, a mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens or fails to improve within 48-72 hrs of AOM onset
Who are the Non-Qualifiers for delayed prescription for AOM (no observation allowed)?
Symptoms suggestive of AOM for more than 48 hrs. Antibiotic therapy w/in past 7 days for any reason. Infant 6 months of age or less. Toxic-appearing child. Hearing impairment. Another episode of AOM w/in the past 3 months. Co-existing bacterial infection
What is the recommended first-line treatment for AOM?
Amoxicillin (80-90mg/kg/day in 2 divided doses). OR. Amoxicillin-Clavulanate (Augmentin; 90mg/kg/day, 14:1 ratio of amox:clav)
What is the alternate first line treatment for AOM if patient has a Penicillin Allergy?
Cefdinir. Cefuroxime. Cefpodoxime. Ceftriaxone (IM/IV, might not be best choice of the CEPHs)
What is the antibiotic of choice if the initial antibiotics failed after 48-72hrs of treatment?
Augmentin (if this was not used for initial therapy). OR. Ceftriaxone
What is an alternate to first line therapy in failed initial therapy?
Ceftriaxone (if Augmentin was used). Clindamying w/ or w/o 3rd gen CEPH
What are the choices if patient failed second antibiotic?
Clindamycin + 3rd gen CEPH. Tympanocentesis. Consult specialist
