Acute Otitis Media Flashcards
Name three common bacterial pathogens that cause Acute otitis Media
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
What are the three reasons why targeting Streptococcus pneumoniae with amoxicillin is considered a good strategy in acute otitis media?
S. pneumoniae is the most common pathogen in AOM.
AOM caused by S. pneumoniae is the least likely to resolve spontaneously.
S. pneumoniae is associated with the greatest likelihood of causing serious complications.
How do S. pneumoniae, H. influenzae, and M. catarrhalis develop resistance to β-lactams?
S. pneumoniae: Alters penicillin-binding proteins.
H. influenzae and M. catarrhalis: Produce β-lactamases.
Additional Information:
Resistance to β-lactams is a common mechanism observed in these bacterial pathogens.
Alteration of penicillin-binding proteins reduces the affinity of β-lactams for their target sites in S. pneumoniae.
Production of β-lactamases by H. influenzae and M. catarrhalis enzymatically degrade β-lactam antibiotics, rendering them ineffective.
What are the key factors contributing to acute otitis media?
Viral upper respiratory tract infection impairing the mucociliary apparatus and causing Eustachian tube dysfunction.
Fluid accumulation in the middle ear due to blockage.
Bacterial entry into the middle ear from the nasopharynx.
Proliferation of bacteria leading to infection.
Additional Information:
The middle ear is located behind the tympanic membrane (eardrum).
A clear tympanic membrane is characteristic of a noninfected ear, while otitis media presents with a bulging and erythematous membrane.
Children are more susceptible due to shorter and more horizontal Eustachian tubes, facilitating bacterial entry.
What does “Unilateral or bilateral AOM without otorrhea” refer to?
Acute otitis media (AOM) occurring in either one or both ears without any discharge or fluid drainage from the ear canal.
Additional Information:
This term encompasses both unilateral (affecting one ear) and bilateral (affecting both ears) presentations of AOM without any visible drainage.
Define “Unilateral AOM without otorrhea.”
Acute otitis media (AOM) affecting only one ear without any discharge or fluid drainage from the ear canal.
Additional Information:
It is a specific presentation of AOM where only one ear is affected, and there is no visible drainage from the affected ear.
This term helps to differentiate between unilateral and bilateral cases of AOM.
What is the definition of “Bilateral AOM without otorrhea”?
Acute otitis media (AOM) affecting both ears simultaneously without any discharge or fluid drainage from either ear canal.
What are common signs of acute otitis media (AOM) in young children?
Irritability and tugging/holding/ rubbing on the ear
Additional Information:
These symptoms may indicate pain or discomfort associated with ear infection.
Parents should monitor their child for signs of AOM and seek medical attention if symptoms persist or worsen.
What is the first-line therapy for acute otitis media (AOM) in most children?
Amoxicillin.
ONLY IF Children Have NOT received amoxicillin in the last 30 days
NO concurrent purulent conjunctivitis.
NO history of recurrent infection unresponsive to amoxicillin.
What are the exceptions to using amoxicillin as the first-line therapy for acute otitis media (AOM) in children?
Children who:
Have received amoxicillin in the last 30 days.
Have concurrent purulent conjunctivitis.
Have a history of recurrent infection unresponsive to amoxicillin. These patients should receive amoxicillin-clavulanate instead of amoxicillin to cover potential resistant organisms or mixed bacterial infections.
What pathogen is more commonly associated with otitis conjunctivitis syndrome?
Haemophilus influenzae. Patients with this syndrome may require treatment with a β-lactamase inhibitor, such as clavulanate, to address potential bacterial resistance.
In which scenarios should antibiotic therapy be initiated for acute otitis media in children?
Antibiotic therapy should be initiated for:
Children 6 months and older with acute otitis media showing severe symptoms (e.g., toxic appearance, persistent ear pain >48 hours, temperature ≥39°C [102.2°F]).
Children 6 months and older with acute otitis media with otorrhea (ear drainage).
Children 6 to 23 months of age with bilateral acute otitis media.
Additional Information:
Antibiotics are recommended to alleviate symptoms, prevent complications, and reduce the risk of recurrence in these cases.
In which scenarios can observation without initial antibiotic treatment be considered for acute otitis media in children?
Observation without initial antibiotic treatment can be considered for:
Children 6 months and older with nonsevere unilateral acute otitis media without otorrhea.
Children 24 months and older with bilateral acute otitis media without otorrhea.
Additional Information:
Watchful waiting allows for monitoring of symptoms before deciding on antibiotic therapy, as many cases of acute otitis media, 78% can resolve on their own without antibiotics.
What is the recommended dosage of amoxicillin for most pediatric patients with acute otitis media?
High-dose amoxicillin (80-90 mg/kg/day in two divided doses)
What are the advantages of using amoxicillin for acute otitis media?
Amoxicillin has the best pharmacodynamic profile against drug-resistant S. pneumoniae, a long record of safety, a narrow spectrum of activity, low cost, and better palatability compared to other options. Higher dosing leads to higher concentrations in middle ear fluid, overcoming most drug-resistant S. pneumoniae.
