AOM Flashcards
Viral causes of AOM
RSV, rhinovirus, influenza, adenovirus
Bacterial causes of AOM
S. pneumoniae, H. influenzae, M. catarrhalis
Infrequent/atypical causes of AOM
Atypicals, Group A strep, gram-negative organisms like Pseudomonas
Which etiology of AOM makes up the most cases?
Bacterial
Risk factors for AOM
young age (<2 years), daycare, recent URTIs which can sometimes precede AOM, nasopharyngeal colonization with middle ear bacterial pathogens, tobacco smoke exposure, bottle feeding, pacifier use, sick sibling(s)
AOM signs and symptoms
FEVER, rhinorrhea, irritability, otaliga, tugging/rubbing of the ear
Otitis media with effusion
Uninfected middle ear effusion- fluid collection behind the tympanic membrane that’s not infected
No acute onset of symptoms
Can precede/follow AOM
AOM definition
rapid onset of signs and symptoms of inflammation in the middle ear
Severe AOM definition
AOM with moderate-to-severe otalgia or fever ≥39ºC
Non-severe AOM
AOM with mild otalgia and temperature <39ºC
Recurrent AOM definition
≥3 well-documented separate AOM episodes in the last 6 months, or ≥4 episodes in the past 12 months with ≥1 episode in the last 6 months
Otitis media with effusion (OME) definition
Inflammation of middle ear with liquid collected in middle ear, but no signs or symptoms of acute infection
Chronic suppurative OM definiton
continuing inflammation of middle ear for at least 6 weeks, leading to perforated tympanic membrane and otorrhea
Antimicrobial resistance with bacterial pathogens in AOM
Over time, there’s been increased resistance to 1st-line ABX like PCNs to treat AOM, so now we need to change the treatment strategy and increase the dose of beta-lactams used, or use combo treatment with beta-lactam/beta-lactamase inhibitors
AOM treatment: PO analgesia
APAP, ibuprofen (more effective in treating pain/fever)
AOM treatment: topical analgesia
Antipyrine, benzocaine, lidocaine may provide short-term pain relief
AOM treatment: naturopathic/homeopathic ear drops for analgesia
May be as effective as analgesic ear drops for short-term pain relief, has blends of oils/herbs
AOM treatment: antihistamines/decongestant analgesia
Don’t use
Mild cases of AOM are ______, there can be ________ within ______.
Mild cases of AOM are self-limiting, there can be improvement within 24 hours
ABX for AOM are recommended in who?
Children with mod-severe signs/symptoms
Otalgia ≥48 hours, temperature ≥39ºC, and/or age <24 months with bilateral AOM
ABX or observation: perforation of the membrane during an episode of AOM
Warrants ABX, regardless of age
ABX or observation: unilateral or bilateral AOM with severe symptoms
Warrants ABX, regardless of age
ABX or observation: bilateral AOM without otorrhea and without severe symptoms
Depends on the age
6 months-2 years: ABX
≥2 years: ABX or observation for 24-48 hours
ABX or observation: unilateral AOM without otorrhea and without severe symptoms
Can treat with ABX or use additional observation, regardless of age
ABX for AOM
Amoxicillin
Amox/clav
AOM amoxicillin dose
90mg/kg/day in 2 divided doses
When to give a child amoxicillin for AOM
Has not received amoxicillin in the past 30 days
Doesn’t have concurrent purulent conjunctivitis
Isn’t allergic to PCN
Amox/clav AOM dose
90mg/kg/day in 2 divided doses
When to give a child amox/clav for AOM
HAS received amoxicillin in the past 30 days
Concurrent purulent conjunctivitis
History of recurrent AOM unresponsive to amoxicillin
Alternative AOM treatments: non-life threatening PCN allergy
PO cephalosporin (cefdinir, cefuroxime, cefpodoxime)
2nd or 3rd generation cephalosporin may be considered
Alternative AOM treatments: life-threatening PCN allergy
macrolide (azithromycin, clarithromycin), clindamycin
Alternative AOM treatments: adherence concerns/allergies
Ceftriaxone 50mg/kg IV x1
Duration of AOM treatment: severe or <2 years old
10 days
Duration of AOM treatment: 2-5 years of age with mild-mod symptoms
7 days
Duration of AOM treatment: ≥6 years with mild-moderate symptoms
5-7 days
When to reassess AOM treatment
If symptoms worsen or fail to improve within 48-72 hours
What to give if initial treatment fails
Augmentin 90mg/kg/day in 2 divided doses
Ceftriaxone 50 mg/kg IV QD x3 days
Clindamycin 30-40 mg/kg/day in three divided doses +/- 3rd generation cephalosporin
Recurrent AOM definition
≥3 episodes in 6 months, or ≥4 episodes in 1 year
Treatment for recurrent AOM
Tympanostomy tubes, adenoidectomy
AOM prevention
Flu vaccine, pneumococcal vaccine, limiting pacifier use when child is asleep
