Acute Otitis Media Flashcards
What is the pathophysiology associated with AOM?
- Patient has a preceding event (usually viral in nature, i.e., in this case – viral URTI)
- Inflammation of the respiratory mucosa
- Edema obstructs pharyngotympanic tube (allowing for poor ventilation and negative middle ear pressure)
- Viruses and bacteria from the URTI enter the middle ear, allowing for microbial growth resulting in clinical signs of AOM
What is the definition of AOM? What is otitis media with effusion?
AOM: presence of inflammation in the middle ear accompanied by S&S of an ear infection
Otitis media with effusion: presence of fluid in the middle ear without S&S of an ear infection
What are the most common pathogens in AOM?
70% of bacterial infections occur due to the following pathogens (in almost all cases!):
- S. pneumoniae (25-50%), 20% spontaneous resolution
- H. influenzae (15-30%), 50% spontaneous resolution
- M. catarrhalis (3-20%), 75% spontaneous resolution
Up to 50% of AOM cases are due to viral causes and resolve without ABX:
- RSV, parainfluenza, influenza, coronavirus, rhinovirus, adenovirus
When is AOM most likely to occur?
Peak incidence < 2 years old, common in 6 months up to 3 years of age, uncommon at 8 years, recurrent AOM affects 15-50% of otitis-prone children
What are the signs and symptoms of AOM? What is the difference between mild and severe AOM?
Most common: otalgia, irritability, fever (50% cases absent)
Mild: absence of pain or mild pain, oral temp < 39
Severe: moderate-severe pain (tugging on ear, redness, insomnia) or oral temp > 39
How is AOM diagnosed?
Certain if: acute onset, MEE, middle ear inflammation
What are the risk factors associated with AOM?
- Children < 2 years
- Childcare attendance or presence of siblings in the home
- Ethnic groups (FN)
- FHx
- Low socioeconomic status
- Second-hand smoke
- Asthma
- Recent episode of influenza/URTI
- Recent ABX use (<3 months)
- Immunocompromised patients
- Eustachian tube obstruction
What is the importance of vaccinations in AOM?
- Influenza vaccine recommended for > 6months with chronic medical conditions: 30% reduction of AOM for children 2+
- Pneumococcal conjugate vaccine: recommended for children 2-23 months and children 2+ at risk of invasive disease (6% reduction of incidence)
- H. influenzae vaccine: little to no impact on H. influenza AOM but likely overall benefits seen
What is watchful waiting?
What are the first-line antibiotic therapies for AOM?
Amoxicillin (SD and HD), , Cefuroxime, Ceftriaxone
What is the dosing for amoxicillin for the treatment of AOM? When is SD considered? HD?
SD Amoxicillin: 45-60 mg/kg/day in 3 divided doses
- Only use in children with no daycare exposure or no ABX use in 90 days
- SD not common due to risk of resistant S. pneumoniae
- In patients with non-life-threatening penicillin allergy, consider cephalosporins
HD Amoxicillin: 75-90 mg/kg/day in 3 divided doses (used to overcome S. pneumoniae resistance)
What is the dosing for amoxicillin-clavulanate for the treatment of AOM? When is this considered?
For initial treatment (no improvement after 2-3 days;
<=35kg: 45-60 mg/kg/day / TID x 10 days
>35kg: 500/125 mg PO TID x 10 days
What are alternatives if amoxi-clav doesn’t work?
clarithromycin, azithromycin, clindamycin
What is the dosing for cefuroxime in the treatment of AOM?
30 mg/kg/day in 2-3 divided doses
What is the dosing for Ceftriaxone in the treatment of AOM?
50 mg/kg IM/IV daily for 3 days
