Acute Otitis Media Flashcards
Acute Otitis Media is the presence of __________ in the middle ear accompanied by the rapid onset of signs and symptoms of an ear infection
INFLAMMATION
AOM is most common in ______
children 6 months - 3 years
Peak incidence between 6-18 months (<2 yo)
Uncommon after 8 years of age
AOM is often preceded by a _____ or ______ respiratory tract infection
viral or bacterial
Up to 50% of AOM cases are due to viral causes and resolve without antibiotic therapy, examples include:
1.
2.
3.
- RSV
- Influenza
- Coronavirus
Most common pathogens involved in AOM
1
2
3
- S. Pneumoniae
- H. Influenzae
- M. Catarrhalis
These two pathogens _________ / __________ are likely to resolve spontaneously
H. Influenzae / M. Catarrhalis
3 Most common symptoms of AOM include
1.
2.
3.
Otalgia (ear pain), Irritability, fever (absent in 50% of cases)
Patients may also experience nasal congestion, cough, loss of appetite, vomiting and discharge
Mild AOM is defined as the absence of ____ or _____ and an oral temperature < ____
pain or mild pain
<39
Sever AOM is defined as ______ on the ear or inability to sleep and redness or oral temperature _____
tugging or inability to sleep / > 39
The most common complication of AOM is ____ ______
Acute mastoiditis
Diagnosis of AOM is certain if the following are present: 1. 2. 3.
- Acute onset 2. Middle-ear effusion 3. middle ear inflammation
Recurrent AOM is defined as >3 episodes in 6 months or ___ episodes in ___ months
4 episodes in 12 months
Risk factors for AOM
1.
2.
3.
etc
- Age (peak 6M - 3 yo)
- Childcare attendance or presence of siblings in home
- second hand smoke
- asthma
- recent episode of influenza/URTI
- Indigenous
- Family history of recurrent OM
- Low socioeconomic status
- Immunocompromised
- Breastfeeding while lying down
The most effective vaccination for reducing AOM for children >2 is _________
Influenza
S pneumoniae vaccine in childhood also helps
AOM diagnosed in > 6 month old, healthy child with NON SEVERE ILLNESS & SYMPTOMS FOR <48 hr should be considered for this approach:
watchful waiting for 1-2 days with antibiotic prescription on hand, if worsening or not improved treat with antibiotics
AOM diagnosed in > 6 month old, healthy child with MODERATELY/SEVERELY ILL or SYMPTOMS for >48 hr should get
antibiotic treatment
AOM diagnosed in babies 6 weeks - 6 months of age automatically should be treated with
antibiotics
Severe AOM is considered as moderate to severe _____ and fever >39
otalgia (ear pain)
Watchful waiting can be considered in the first 1-2 days in children >6 months of age with the following:
1
2.
3.
4.
- non severe illness
- uncomplicated
- no serious comorbidities
- guardian is able to recognize when illness is worsening
Duration of therapy for AOM
1. > 2 yo (uncomplicated) =
2. < 2 yo =
- 5 days
- 10 days (also for recurrent AOM, or AOM + perforated tympanic membrane or treatment failure)
First line antibiotics for AOM treatment:
1.
2
3
Amoxicillin (SD/HD)
Cefuroxime
Ceftriaxone
High dose amoxicillin in AOM is used to over come _____
Strep Pneumoniae resistance
High dose amoxicillin in AOM should be considered if the patient:
1.
2.
- has had recent antibiotic exposure <90 days
- attend daycare or have siblings in daycare
Initial treatment failure of AOM (no improvement after 2-3 days) should be treated with:
Amox-Clav
If a patient with AOM has Type 1 hypersensitivity aka a life threatening penicillin allergy what alternate treatments can you use
1.
2.
3.
- Azithromycin
- Clarithromycin
- Clindamycin
_________ (antibiotic) should be considered for patients who fail amox/clav therapy of AOM
Ceftriaxone
AOM
Gram stain shows
Gram neg diplococci or coccobacilli
Assuming limited recent exposures to antimicrobials which of the following antibiotics should not be used empirically for this patient:
a Clindamycin
b Cefuroxime
c Amox-Clav
d Azithromycin
A - Clindamycin DOES NOT have activity against gram negative organisms
