Acute otitis media Flashcards
Symptoms of AOM
fever, ear pain
red and swollen eardrum
sometimes ear drainage
Watchful waiting period length
upto 48 hours due to spontaneous recovery in 80% of children
Risk factors in which watchful waiting should not occur
- children 6 weeks to 6 months
- attends daycare
3.Abx used in last 3 months - recurrent AOM
Pathogens in AOM
S. pneumo
M. catarrhalis
H. influenza
Who should receive high dose of amoxicillin?
Age > 2 years old + risk factors ( < 3 months abx exposure, daycare, recent AOM)
Dose: 80-90 mg/kg/day divided BID for 5 days
Who should receive a standard dose of amoxicillin?
Ag > 2 y/o + no risk factors
Dose: 40-50 mg/kg/day x 5 days
Dosing for children < 2 years old
if risk factors, give high dose.
for children < 2, longer duration of tx = 10 days (not 5 days)
Patient is allergic to penicillins. What are the next best options?
azithromycin once daily qhs x 5 days or clarithromycin
Patient Y was taking amoxicillin for AOM for 3 days and still no symptom relief. If treatment failure occurs, what can be prescribed next?
high dose amoxi/clav
cefprozil po (H. inf + M. catt)
cefuroxime po (H. inf + M. catt)
ceftriaxone (IV/IM only) x 3 days
After starting antibiotics, when should clinical improvement be noticed?
within 48 to 72 hrs
For treatment failure, when to refer pt?
Refer to EENT specialist if 3+ episodes in 6 months, or 4+ episodes in 1 year
Vaccines for prevention of AOM?
If < 5 y/o + frequent AOM, consider prevnar-13-C (4 doses) and influenza vaccine every year. Treatment of AOM for 10 days.
For all ages, give influenza vaccine each yea.
A patient presents with ear wax. When to refer?
wax build up leading to hear loss, pain, foreign object in ear canal
For bacterial otitis externa, what bacteria is involved?
P. aeruginosa
S. aureus
Treatment for otitis externa if OTC is not working?
FQ ear drops or aminoglycoside ear drops or acetic acid 2% ear drops
