AOM Flashcards

(40 cards)

1
Q

Viral causes of AOM

A

RSV, rhinovirus, influenza, adenovirus

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2
Q

Bacterial causes of AOM

A

S. pneumoniae, H. influenzae, M. catarrhalis

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3
Q

Infrequent/atypical causes of AOM

A

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

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4
Q

Which etiology of AOM makes up the most cases?

A

Bacterial

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5
Q

Risk factors for AOM

A

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)

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6
Q

AOM signs and symptoms

A

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

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7
Q

Otitis media with effusion

A

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

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8
Q

AOM definition

A

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

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9
Q

Severe AOM definition

A

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

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10
Q

Non-severe AOM

A

AOM with mild otalgia and temperature <39ºC

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11
Q

Recurrent AOM definition

A

≥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

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12
Q

Otitis media with effusion (OME) definition

A

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

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13
Q

Chronic suppurative OM definiton

A

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

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14
Q

Antimicrobial resistance with bacterial pathogens in AOM

A

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

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15
Q

AOM treatment: PO analgesia

A

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

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16
Q

AOM treatment: topical analgesia

A

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

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17
Q

AOM treatment: naturopathic/homeopathic ear drops for analgesia

A

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

18
Q

AOM treatment: antihistamines/decongestant analgesia

19
Q

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

A

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

20
Q

ABX for AOM are recommended in who?

A

Children with mod-severe signs/symptoms

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

21
Q

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

A

Warrants ABX, regardless of age

22
Q

ABX or observation: unilateral or bilateral AOM with severe symptoms

A

Warrants ABX, regardless of age

23
Q

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

A

Depends on the age

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

24
Q

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

A

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

25
ABX for AOM
Amoxicillin Amox/clav
26
AOM amoxicillin dose
90mg/kg/day in 2 divided doses
27
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
28
Amox/clav AOM dose
90mg/kg/day in 2 divided doses
29
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
30
Alternative AOM treatments: non-life threatening PCN allergy
PO cephalosporin (cefdinir, cefuroxime, cefpodoxime) 2nd or 3rd generation cephalosporin may be considered
31
Alternative AOM treatments: life-threatening PCN allergy
macrolide (azithromycin, clarithromycin), clindamycin
32
Alternative AOM treatments: adherence concerns/allergies
Ceftriaxone 50mg/kg IV x1
33
Duration of AOM treatment: severe or <2 years old
10 days
34
Duration of AOM treatment: 2-5 years of age with mild-mod symptoms
7 days
35
Duration of AOM treatment: ≥6 years with mild-moderate symptoms
5-7 days
36
When to reassess AOM treatment
If symptoms worsen or fail to improve within 48-72 hours
37
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
38
Recurrent AOM definition
≥3 episodes in 6 months, or ≥4 episodes in 1 year
39
Treatment for recurrent AOM
Tympanostomy tubes, adenoidectomy
40
AOM prevention
Flu vaccine, pneumococcal vaccine, limiting pacifier use when child is asleep