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Fall 2014 - Pharm GI/ENT > Acute Otitis Media > Flashcards

Acute Otitis Media Flashcards

1
Q

When are AOM episodes most frequent? (who gets it the most)

A

first three years of life (infants and toddlers)

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2
Q

What % of healthcare visits for AOM resulted in antibiotic Rx?

A

80%

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3
Q

What % of pts with OM have virus in their nasopharyngeal secretions?

A

42%

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4
Q

Common Bacterial Pathogens Causing AOM

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
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5
Q

S. pneumoniae Prevalence

A
  • 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
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6
Q

What type of bacteria is H. flu?

staining, morphology, resistance

A
  • gram negative rod

- some strains beta-lactamase producing

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7
Q

What condition might AOM H.flu also present with?

A

-may present concomitantly with conjunctivitis

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8
Q

What type of bacteria is M. cat?

stain, morphology, resistance

A
  • gram negative diplococci

- 100% beta-lactamase producing

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9
Q

Risk Factors for OM

A
  • 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
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10
Q

Risk Factors for Resistant AOM Pathogens

A
  • daycare attendance
  • age <2 years
  • recent abx use in past 3 months
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11
Q

Dx of AOM

A
  • 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
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12
Q

Possible Txs for Otalgia in AOM (just list them)

A
  • 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
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13
Q

Why might benzocaine, procaine or lidocaine be used for otalgia in AOM?

A

-additional (but brief) benefit over acetaminophen in pts > 5 y.o.

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14
Q

What are the advantages and disadvantages of narcotic analgesia with codeine in AOM otalgia?

A
  • effective for moderate or severe pain
  • requires prescription
  • risk of respiratory depression, altered mental status, GI upset, constipation
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15
Q

Initial Management of Otorrhea with AOM

age 6 mos to >2 years

A

-antibiotic therapy

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16
Q

Initial Management of Unilateral or Bilateral AOM w/ Severe Sxs

(age 6 mos to >2 years)

A

-antibiotic therapy

17
Q

Initial Management of Bilateral AOM without Otorrhea

  1. 6 mo to 2 years
  2. > 2 years
A
  1. antibiotic therapy

2. antibiotic therapy or additional observation

18
Q

Initial Management of Unilateral AOM without Otorrhea

age 6 mos to >2 years

A

-antibiotic therapy or additional observation

19
Q

Factors to Take Into Account when Selecting Abx for OM

A
  • 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
20
Q

FIRST LINE Initial Immediate or Delayed Abx Tx

A

-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)

21
Q

ALTERNATIVE Initial Immediate or Delayed Abx Tx

in cases of PCN allergies

A
  • 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)
22
Q

FIRST LINE Tx after 48-72h or Failure of Initial Tx

A

-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)

23
Q

ALTERNATIVE Tx after 48-72h or Failure of Initial Tx

A
  • 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
24
Q

Amoxicillin Capsule Dosages

A

-250 or 500 mg

25
Q

Amoxicillin Suspension Dosages

A
  • 125 and 250 mg/5 mL

- 200 and 400 mg/5 mL

26
Q

Amoxicillin Chewable Tablet Dosages

A
  • 125 and 250 mg

- 200 and 400 mg

27
Q

Augmentin Tablet Dosages

A
  • 250/125 mg
  • 500/125 mg
  • 875/125 mg
28
Q

Augmentin Tablet ER Dosage

A

-1000/62.5 mg

29
Q

Augmentin Suspension Dosages

A
  • 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
30
Q

Augmentin Chewable Tablet Dosages

A
  • 125/31.25 and 250/62.5 mg

- 200/28.5 and 400/57 mg

31
Q

Duration of Tx for Kids <2 with Severe Sxs

A

10 days

32
Q

Duration of Tx for Kids 2-5 with Mild to Moderate Sxs

A

7 days

33
Q

Duration of Tx for Kids >6 with Mild to Moderate Sxs

A

5-7 days

34
Q

Monitoring AOM Tx

A
  • 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
35
Q

What role do prophylactic abx play in OM?

A

-NOT recommended to reduce frequency of AOM episodes in kids with recurrent AOM

36
Q

Would should tympanostomy tubes be considered?

A

-for recurrent AOM: 3 episodes in 6 months or 4 episodes in 1 year, with 1 episode in preceding 6 months

37
Q

What is recommended to help prevent OM infections?

A
  • pneumococcal conjugate vaccine and annual influenza for all kids
  • encourage exclusive breastfeeding for at least 6 months
  • encourage avoidance of tobacco smoke exposure

Fall 2014 - Pharm GI/ENT (14 decks)

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