12 - Pediatric Disease

Question 1

Risk for AB resistance with….

Answer 1

broader spectrum agents

↑use of AB’s

<2 y/o (younger age)

winter

day-care attendence + # of kids in daycare

recent AB use (past 30 days)

Question 2

Symptoms of Otitis Media

Answer 2

• *Pain (OTALGIA) & Fever**
• AOM*
• *Hearing Impairment**
• OME - PERSISTANT effusion*

Otorrhea = Discharge from ear
perforation
or
Tympanostomy tube placed
used for CHRONIC suppurative otitis media

Question 3

WHY do kids get ear infections?

Answer 3

ANATOMY

• *EUSTACHIAN TUBE ANGLE** (straighter than adults)
• *Cleft Palate**
• *BOTTLE FEEDING**
• breast feeding = BETTER, angles milk in the right angle*

Day Care Attendance

Smoking

• *RESPIRATORY INFECTIONS**
• *tears / mucus –> enters ear**

Question 4

WHY do we TREAT
Otitis Media?

Answer 4

95% resolution vs 80% w/o AB’s

REDUCE COMPLICATIONS
ESP - HEARING IMPAIRMENT
&
Mastoiditis (infammation of mastoid)

Question 5

WHICH ORGANISMS
cause
AOM

Answer 5

1 = STREPTOCOCCUS PNEUMONIAE

• *VIRUS = MOST COMMON**
• advocate to VACCINATE –> Influenze & Pneumococcal*

Moraxella Catarrhalis + HaemoPhilus Influenza

• Staphylococcus Aureus*
• rare but need for CLINDA for this*

Question 6

Pain Management for AOM

Answer 6

Initiated within First 24 Hours if possible

• *APAP**
• *Ibuprofen**
• Topical Analgesics = Benzocaine (Auralgan)*
• Herbal Alternatives*

Question 7

When to consider:
OBSERVATION

Answer 7

Based on:
Age & Severity

Healthy Children:
6mo - 2y/o w/ non-severe illness & unilateral involvement
or
> 2 y/o** w/ **non-severe** illness & **no otorrhea (ear discharge)

Observation is:
Defer AB therapy for 48-72 hours
Schedule an RE-Evalulation // Communication
SNAP –> don’t fill RX until DR. conformation

Question 8

1st Line Treatment
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

Answer 8

AMOXICILLIN** @ **80-90 mg/kg/day BID
HIGH DOSE –> needs to reach MIDDLE EAR

OR

OBSERVATION
defer AB for 48-72 hours
if observed & failed after 48-72 hours –> AMOX 80-90

Question 9

2nd Line Treatment
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

Answer 9

After Failing AMOXICILLIN +/- Observation:

AUGMENTIN** @ **80-90 mg/kg/day
BID

Question 10

Treatment if PCN allergy
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

Answer 10

Cefuroxime - BID

or

Cefdinir - QD or BID

Question 11

3rd Line Treatment
For
NON-SEVERE AOM

Mild Symptoms / Unilateral Infxn / No Otorrhea
Fever < 39* (102.2F)

Answer 11

After Failing AMOXICILLIN +/- Observation:
&
Failing AUGMENTIN:

CEFTRIAXONE - IM QD F3D

• *CLINDAMYCIN**
• may need ADDITIONALLY to cover* H.Influenzae

TYMPANOCENTESIS
TUBE to withdraw fluid or pus from middle ear

Question 12

1st Line Treatment
For
SEVERE AOM

BILATERAL infection / OTORRHEA
Fever > 39*C (102.2*F)

Answer 12

AUGMENTIN** @ **80-90 mg/kg/day BID

Question 13

2nd Line Treatment
For
SEVERE AOM

BILATERAL infection / OTORRHEA
Fever > 39*C (102.2*F)

Answer 13

• *CEFTRIAXONE**
• *IM QD x 3 days**

or

Cefdinir
QD - BID

Cefuroxime
BID

Question 14

LAST LINE THERAPY
for
AOM

Answer 14

• FAILURE of*
• *Augmentin** –> 3-day course of CEFTRIAXONE..

Tympanocentesis + Gram Stain
TUBE –> withdraw fluid or pus from middle ear

Clindamycin
ADDED –> need 2nd AB to cover H.Influenzae
cephalosporin

Question 15

When to think ALTERNATIVE
to First Line therapy?

Answer 15

Recent AB use = <4 weeks
Amoxicillin in past 30 days –> start w/ augmentin

Resistance

Daycare Attendance

Treatment Failure

CULTURES

Question 16

RECURRENT AOM

Answer 16

>3 infxn in 6 months

or

> 4 in 1 Year w/ 1 infxn in past 6 monhts

NO PROPHYLAXIS RECOMMENDED

Question 17

How to
DECREASE RISK FACTORS
for AOM

Answer 17

↓Child-care attenence

Avoid Supine Bottle Feeding

BREAT FEEDING x 1st 6-months

↓Pacifier Use in 2nd 6-months

VACCINATE
Pneumococcal + Influenzae

Question 18

Acute Otitis EXTERNA

Answer 18

Classic SWIMMERS EAR does NOT NEED ANTIBIOTICS

Cipro HC 0.2%
for > 1y/o

CiproDex 0.3%
also for AOM w/ Tympanostomy Tubes
for > 6mo

Question 19

When to suggest 10 Days of
Augmentin or Amoxicillin Therapy for AOM

Answer 19

< 2 y/o for ANY

SEVERE AOM for ANY

Question 20

When to Suggest < 10 day therapy
for
AOM

Answer 20

7 DAY THERAPY for:
2-5 y/ow/mild-Moderate AOM

• *5-7 Day Therapy** for:
• *>** 6y/o