AOM

Question 1

Viral causes of AOM

Answer 1

RSV, rhinovirus, influenza, adenovirus

Question 2

Bacterial causes of AOM

Answer 2

S. pneumoniae, H. influenzae, M. catarrhalis

Question 3

Infrequent/atypical causes of AOM

Answer 3

Atypicals, Group A strep, gram-negative organisms like Pseudomonas

Question 4

Which etiology of AOM makes up the most cases?

Answer 4

Bacterial

Question 5

Risk factors for AOM

Answer 5

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)

Question 6

AOM signs and symptoms

Answer 6

FEVER, rhinorrhea, irritability, otaliga, tugging/rubbing of the ear

Question 7

Otitis media with effusion

Answer 7

Uninfected middle ear effusion- fluid collection behind the tympanic membrane that’s not infected
No acute onset of symptoms
Can precede/follow AOM

Question 8

AOM definition

Answer 8

rapid onset of signs and symptoms of inflammation in the middle ear

Question 9

Severe AOM definition

Answer 9

AOM with moderate-to-severe otalgia or fever ≥39ºC

Question 10

Non-severe AOM

Answer 10

AOM with mild otalgia and temperature <39ºC

Question 11

Recurrent AOM definition

Answer 11

≥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

Question 12

Otitis media with effusion (OME) definition

Answer 12

Inflammation of middle ear with liquid collected in middle ear, but no signs or symptoms of acute infection

Question 13

Chronic suppurative OM definiton

Answer 13

continuing inflammation of middle ear for at least 6 weeks, leading to perforated tympanic membrane and otorrhea

Question 14

Antimicrobial resistance with bacterial pathogens in AOM

Answer 14

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

Question 15

AOM treatment: PO analgesia

Answer 15

APAP, ibuprofen (more effective in treating pain/fever)

Question 16

AOM treatment: topical analgesia

Answer 16

Antipyrine, benzocaine, lidocaine may provide short-term pain relief

Question 17

AOM treatment: naturopathic/homeopathic ear drops for analgesia

Answer 17

May be as effective as analgesic ear drops for short-term pain relief, has blends of oils/herbs

Question 18

AOM treatment: antihistamines/decongestant analgesia

Answer 18

Don’t use

Question 19

Mild cases of AOM are ______, there can be ________ within ______.

Answer 19

Mild cases of AOM are self-limiting, there can be improvement within 24 hours

Question 20

ABX for AOM are recommended in who?

Answer 20

Children with mod-severe signs/symptoms

Otalgia ≥48 hours, temperature ≥39ºC, and/or age <24 months with bilateral AOM

Question 21

ABX or observation: perforation of the membrane during an episode of AOM

Answer 21

Warrants ABX, regardless of age

Question 22

ABX or observation: unilateral or bilateral AOM with severe symptoms

Answer 22

Warrants ABX, regardless of age

Question 23

ABX or observation: bilateral AOM without otorrhea and without severe symptoms

Answer 23

Depends on the age

6 months-2 years: ABX
≥2 years: ABX or observation for 24-48 hours

Question 24

ABX or observation: unilateral AOM without otorrhea and without severe symptoms

Answer 24

Can treat with ABX or use additional observation, regardless of age

Question 25

ABX for AOM

Answer 25

Amoxicillin Amox/clav

Question 26

AOM amoxicillin dose

Answer 26

90mg/kg/day in 2 divided doses

Question 27

When to give a child amoxicillin for AOM

Answer 27

Has not received amoxicillin in the past 30 days Doesn’t have concurrent purulent conjunctivitis Isn’t allergic to PCN

Question 28

Amox/clav AOM dose

Answer 28

90mg/kg/day in 2 divided doses

Question 29

When to give a child amox/clav for AOM

Answer 29

HAS received amoxicillin in the past 30 days Concurrent purulent conjunctivitis History of recurrent AOM unresponsive to amoxicillin

Question 30

Alternative AOM treatments: non-life threatening PCN allergy

Answer 30

PO cephalosporin (cefdinir, cefuroxime, cefpodoxime) 2nd or 3rd generation cephalosporin may be considered

Question 31

Alternative AOM treatments: life-threatening PCN allergy

Answer 31

macrolide (azithromycin, clarithromycin), clindamycin

Question 32

Alternative AOM treatments: adherence concerns/allergies

Answer 32

Ceftriaxone 50mg/kg IV x1

Question 33

Duration of AOM treatment: severe or <2 years old

Answer 33

10 days

Question 34

Duration of AOM treatment: 2-5 years of age with mild-mod symptoms

Answer 34

7 days

Question 35

Duration of AOM treatment: ≥6 years with mild-moderate symptoms

Answer 35

5-7 days

Question 36

When to reassess AOM treatment

Answer 36

If symptoms worsen or fail to improve within 48-72 hours

Question 37

What to give if initial treatment fails

Answer 37

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

Question 38

Recurrent AOM definition

Answer 38

≥3 episodes in 6 months, or ≥4 episodes in 1 year

Question 39

Treatment for recurrent AOM

Answer 39

Tympanostomy tubes, adenoidectomy

Question 40

AOM prevention

Answer 40

Flu vaccine, pneumococcal vaccine, limiting pacifier use when child is asleep