Acute Otitis Media Flashcards
When are AOM episodes most frequent? (who gets it the most)
first three years of life (infants and toddlers)
What % of healthcare visits for AOM resulted in antibiotic Rx?
80%
What % of pts with OM have virus in their nasopharyngeal secretions?
42%
Common Bacterial Pathogens Causing AOM
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
S. pneumoniae Prevalence
- prevalence of resistant S. pneumoniae is > in kids than adults
- resistant S. pneumo esp. common in kids <2, kids in daycare, kids receiving abx in previous 3 months
What type of bacteria is H. flu?
staining, morphology, resistance
- gram negative rod
- some strains beta-lactamase producing
What condition might AOM H.flu also present with?
-may present concomitantly with conjunctivitis
What type of bacteria is M. cat?
stain, morphology, resistance
- gram negative diplococci
- 100% beta-lactamase producing
Risk Factors for OM
- allergies, tobacco smoke exposure
- anatomic defects (cleft palate)
- GERD
- immundodeficiency
- males, Native American or Inuit, positive family hx, siblings
- viral resp infection
- young age at first dx, daycare attendance, lack of breastfeeding, pacifier use
Risk Factors for Resistant AOM Pathogens
- daycare attendance
- age <2 years
- recent abx use in past 3 months
Dx of AOM
- moderate to severe bulging of tympanic membrane or new onset of otorrhea not due to acute otitis externa
- mild bulging of TM and recent onset of ear pain (holding, tugging, rubbing of ear) or intense erythema of TM
Possible Txs for Otalgia in AOM (just list them)
- acetaminophen, ibuprofen
- home remedies (heat or cold, oil drops in external auditory canal)
- topical agents: benzocaine, lidocaine
- homeopathic agents
- narcotic analgesia w/ codeine or analogs
- tympanostomy/myringotomy
Why might benzocaine, procaine or lidocaine be used for otalgia in AOM?
-additional (but brief) benefit over acetaminophen in pts > 5 y.o.
What are the advantages and disadvantages of narcotic analgesia with codeine in AOM otalgia?
- effective for moderate or severe pain
- requires prescription
- risk of respiratory depression, altered mental status, GI upset, constipation
Initial Management of Otorrhea with AOM
age 6 mos to >2 years
-antibiotic therapy
Initial Management of Unilateral or Bilateral AOM w/ Severe Sxs
(age 6 mos to >2 years)
-antibiotic therapy
Initial Management of Bilateral AOM without Otorrhea
- 6 mo to 2 years
- > 2 years
- antibiotic therapy
2. antibiotic therapy or additional observation
Initial Management of Unilateral AOM without Otorrhea
age 6 mos to >2 years
-antibiotic therapy or additional observation
Factors to Take Into Account when Selecting Abx for OM
- coverage of common pathogens, local bacterial resistance patterns, recent abx therapy
- available formulations, pt age, side effects, pt allergy, taste
- cost
- frequency of doses
- concomitant dz states
FIRST LINE Initial Immediate or Delayed Abx Tx
-amoxicillin 80-90 mg/kg per day in 2 divided doses
OR
-amoxicillin-clavulanate (90 mg/kg per day of amoxicillin with 6.4 mg/kg per day of clavulanate in 2 divided doses)
ALTERNATIVE Initial Immediate or Delayed Abx Tx
in cases of PCN allergies
- cefdinir (14 mg/kg per day in 1-2 doses)
- cefuroxime (30 mg/kg per day in 2 divided doses)
- cefpodoxime (10 mg/kg per day in 2 divided doses)
- ceftriaxone (50 mg IM or IV per day for 1 or 3 days)
FIRST LINE Tx after 48-72h or Failure of Initial Tx
-amoxicillin-clavulanate (90 mg/kg per day of amoxicillin with 6.4 mg/kg per day of clavulanate in 2 divided doses)
OR
-ceftriaxone (50 mg IM or IV per day for 1 or 3 days)
ALTERNATIVE Tx after 48-72h or Failure of Initial Tx
- ceftriaxone x3 days
- clindamycin (30-40 mg/kg per day in 3 divided doses) +/- 3rd gen cephalosporin
- failre of second antibiotic: clindamycin (30-40 mg/kg in 3 divided doses) plus 3rd gen ceph
- tympanocentesis
- consult specialist
Amoxicillin Capsule Dosages
-250 or 500 mg
Amoxicillin Suspension Dosages
- 125 and 250 mg/5 mL
- 200 and 400 mg/5 mL
Amoxicillin Chewable Tablet Dosages
- 125 and 250 mg
- 200 and 400 mg
Augmentin Tablet Dosages
- 250/125 mg
- 500/125 mg
- 875/125 mg
Augmentin Tablet ER Dosage
-1000/62.5 mg
Augmentin Suspension Dosages
- 125/31.25 and 250/62.5 mg/5 mL
- 200/28.5 and 400/57 mg/5 mL
- 600/42.9 mg/5 mL
Augmentin Chewable Tablet Dosages
- 125/31.25 and 250/62.5 mg
- 200/28.5 and 400/57 mg
Duration of Tx for Kids <2 with Severe Sxs
10 days
Duration of Tx for Kids 2-5 with Mild to Moderate Sxs
7 days
Duration of Tx for Kids >6 with Mild to Moderate Sxs
5-7 days
Monitoring AOM Tx
- sxs may start to stabilize in first 24 hours
- sxs should begin to improve in 24-48 hours
- if no improvement in 72 hours, consider change in abx therapy
- ear effusions last average 2-4 weeks
What role do prophylactic abx play in OM?
-NOT recommended to reduce frequency of AOM episodes in kids with recurrent AOM
Would should tympanostomy tubes be considered?
-for recurrent AOM: 3 episodes in 6 months or 4 episodes in 1 year, with 1 episode in preceding 6 months
What is recommended to help prevent OM infections?
- pneumococcal conjugate vaccine and annual influenza for all kids
- encourage exclusive breastfeeding for at least 6 months
- encourage avoidance of tobacco smoke exposure
