Acute Otitis Media

Question 1

When to refer in acute ottitis media?

Answer 1

When treatment fails you can consider

when otitis media becomes frequent (>3 episodes in 6 months or 4 in 1 year)

Reccurnt episodes of AOM for an audiology assessment to monitor for conductive hearing loss

Question 2

What is the fever threshold for “non severe”

Answer 2

<39C

Question 3

How long can you do watchful waiting?

Answer 3

usually 24 - 48 hrs

Question 4

Age cut off for watchful waiting

Answer 4

<6 months

Question 5

Pain control in AOM?

Answer 5

Acetaminophen (10-15mg/kg Q4-6H) max 75mg/kg/d (4g absolute max)

Ibuprofen 5-10mg/kg Q6-8H max 40mg/kg/day max 2.4g

Question 6

What bacteria is primarly involved in AOM?

Answer 6

S pneumonia, H influenza, M catarrhalis

Question 7

What strategies should be used for each causitive organism?

Answer 7

S pneumonia w/ pen resistnace can be treated with high dose amoxi

H. influ, M. catarrhalis need clavulanate

Question 8

First line for AOM?

Answer 8

Amoxi (standard or high dose depending on patient)
Amoxi/clav

Alts:
Clindamycin (used last line for patients CI to first lines) covers S pneumonia but not others
Cefuroxime axetil and cefprozil
Ceftriaxone (3 days vs other treatments 5 and 10 days)
azithro / clarythromycin (if you cant use B lactams)

Question 9

CPS Abio recomendations for differing age groups

Answer 9

<6 weeks: das a baby, investiagate for bactermia and get it to the emerg department

6 weeks - 6 months: stardard or HD amoxi: TREAT MOST FOR 5 days

> 6 months (watchful waiting comes in here) standard or HD amoxi (<2 YO treat for 10 days) else treat for 5

> 6 months w/ risk factors: same as above but use on HD amoxi

Recurrent AOM at any age: HD amoxi/clav only for first line and treat for 10 days

Pen allergy: clarithro 10d azith 3d are alternatives

Question 10

Risk factors that indicate HD needed

Answer 10

recent Abio use
daycare attendance (kids are dirty yo)
recent episode of acute otitis media
treatment failure or early recurrence
toxic appearance
>39C fever
severe otalgia (rubbing ear, cant sleep, irratble for infants)

Question 11

how long to wait to guage treatment efficacy?

Answer 11

Should see improvement in 24-48hrs if nothing changes on day 3 can consider step up or alt (ie amoxi/clav)

Question 12

What is HD amox?

Answer 12

75-90mg/kg/day BID

standard is 40-50 TID instead

Question 13

common symptoms of AOM

Answer 13

ear pain, irritability with or without fever

Question 14

criteria for watchful waiting

Answer 14

> 6 months PLUS

• non severe illness
• uncomplicated AOM
• no serious comorbidities
• guardian is able to recognize when illness is worsening

Question 15

1st line in non-life threatening penicillin allergy

Answer 15

cephalosporin: Cefuroxime 30mg/kg in 2-3 divided doses

ceftriaxone 50mg/kg IM/IB daily for 3 days

Question 16

initial treatment failure

Answer 16

amox/clV: <35KG: 45-60mg/kg/day in 3 divided doses x 10 days

> 35kg: 500/120 mg PO TID X 10 DAYS

Question 17

alternative for life threatening pen allergies

Answer 17

clarithromycin, azithromycin , clindamycin