AOM

Question 1

Risk factors for AOM

Answer 1

Day care/crowded living conditions
orofacial anomalies (cleft palate, Down)
cigarette smoke
pacifier use 
shorter duration breast feeding
prolonged bottle feeding supine
family history recurrent otitis
first nations or inuit

Question 2

most common bugs in AOM

Answer 2

1. s. pneumo (number 1)
2. hib (non-typable)
3. moraxella
4. GAS (less common)

Question 3

less virulent bacterial causes of AOM likely to resolve spontaneously

Answer 3

M catarrhalis

non-typable Hib

Question 4

bacterial cause of perforated AOM

Answer 4

GAS

Question 5

diagnostic criteria for AOM

Answer 5

acute symptoms (fever, erythema)
bulging TM
MEE

Question 6

most common complication of AOM

Answer 6

mastoiditis
less comon
CN VII palsy
CN VI palsy (Gradenigo)
venous sinus thrombosis
meningitis

Question 7

what if does not respond to amoxil? which bug is it

Answer 7

likely m. catarrhalis or Hib

needs second gen cephalosporin or amox clav

Question 8

NNT for otitis media with abx if bulging and ill

Answer 8

4

Question 9

if perforated TM with purulent drainage

Answer 9

treat with antimicrobials x 10 days (amox should be ok)

Question 10

If MEE and Bulging TM

-> moderately ill with poor response to antipyretics or > 48 hours of symptoms

Answer 10

treat with abx
if 6 months-2 years x 10 days
if > 2 years x 5 days

Question 11

if no MEE or MEE with non bulging

Answer 11

think viral

reassess in 24-48 hours

Question 12

if MEE and Bulging but good response to antipyretics, mild otalgia, sx less than 48 hours
temp < 39 without antipyretics

Answer 12

reassess in 48 hours, recommend regular analgesia

if not improved or worsend tx with abx

Question 13

Amox dosing for AOM

Answer 13

45-60 mg/kg/day TID OR

75-90 mg/kg/day BID to ensure adequate abx levels in middle ear

Question 14

first line tx of otitis-conjunctivitis syndrome (i.e. purulent conjunctivitis with otitis media)

Answer 14

tx with second gen cephalosporin like cefuroxime axetil because probably caused by m catarrhalis or Hib

Question 15

What if had treatment for an infection with amoxil in the past 30 days?

Answer 15

consider amox clav as first line instead

Question 16

what if fails second line amox-clav

Answer 16

ceftriaxone IM or IV x 3 days 50 mg/kg

Question 17

amox clav suspension preferred

Answer 17

7:1 formulation
i.e. 400 mg/5 mL suspension 7:1
because it has the less than 10 mg/kg/day clavulanate required to cause diarrhea