B3-054 - AOM and OME Flashcards

1
Q

______ is the most common reason for Antibiotic prescriptions in children

A

Otitis Media

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2
Q

Rates of otitis media are _____

A

Declining

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3
Q

Why are fewer people visiting the doctors office for OM?

A
  • increased cost of copayments
  • increased public education
  • use of conjugated pneumococcal vaccine
  • increased flu vaccine
  • better differentiation between AOM and OME
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4
Q

AOM

A

Acute Otitis Media

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5
Q

OME

A

Otitis Media with Effusion

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6
Q

Path of AOM

A

usually occurs with or following viral upper respirator tract infection (URI)

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7
Q

75% of URI have______

A

Eustachian tube dysfunction

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8
Q

Breakdown of bacteria/viral distribution of AOM cases

A

66% - bacterial and viral
27% - bacterial only
4% - viral only

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9
Q

Bacterial culprits of AOM

A
  • Strep. pneumonia
  • nontypal Haemaphilus influenza (nTHi)
  • Moraxella catarrhalis
  • Strep. pyogenes (school age children)
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10
Q

Age distribution of 1st episode of AOM

A
  • 16% 0-6m
  • 44% 7-18m
  • 40% 19m-2yr
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11
Q

___% of children with OM had more than 4 episodes of AOM

A

40%

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12
Q

Risk factors for AOM

A
  • day care
  • non-hispanic white
  • atopy
  • siblings
  • family history
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13
Q

Symptoms of AOM

A
  • rapid onset ear pain (50-60% of cases)
  • young children: tugging at ears, fever, excessive crying, changes in sleep
    Best: “cloudy”, bulging TM with impaired mobility
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14
Q

Bulging TM is highly _____, whereas impaired TM mobility is highly _____.

A

specific; sensitive.

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15
Q

OME path

A

Often aftermath of AOM or consequence of Eustachian tube dysfunction from URI
Can precede AOM

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16
Q

OME and antibiotics

A

Should AVOID

17
Q

AOM diagnosis

A

Moderate to severe bulging TM or new onset ear liquid not from AOE

OR

Mild bulging of TM and recent (within 48 hr) ear pain of intense erythema of the TM

18
Q

AOM diagnosis must have ______

A

Middle ear effusion (MEE)

19
Q

When is observation treatment an option?

A
  • 6m-2yr non severe, unilateral
  • 2+ year, non severe, unilateral
  • 2+ year, non severe, bilateral
20
Q

Drug of choice for AOM

A

Amoxicillin 80-90mg/kg/day divided bid. Reassess within 48-72 hrs

21
Q

OME

A

Fluid in ear, without pain or bulging of TM

22
Q

Most cases of OME resolve within ___

A

3 months

23
Q

____% of children have repeat OME

A

30-40%

24
Q

___% of OME episodes last more than 1 year

A

5-10%

25
Q

___% of OME last more than 3 months

A

25%

26
Q

“Watchful Waiting” protocol

A
  • no ABx, anti-hist, decongestants, or steroids
  • After 3m, get a hearing test
27
Q

Who is at risk for OME

A
  • CMV, downs syndrome, cleft palate, blind
28
Q

Rough Surgery Guidelines for Tubes

A
  • Less than 4yr: tubes
  • 4+ yrs: tubes and/or adenoidectomy
29
Q

AOM - First Line Treatment for Initial Antibiotic Therapy

A

Amoxicillin (80-90 mg/kg/day in 2 divided doses)
or
Add clavulanate if pt received amoxicillin within previous 30 days

30
Q

AOM - First Line Alternative treatment if allergic to PCNs

A

Cefdiner, Cefuroxime, Cefpodoxime, Ceftriaxone (50mg/kg IM or IV for 3 days)

31
Q

AOM - ABx treatment after 48-72hrs of Failure of Initial Therapy

A

Add Clavulanate to amoxicillin if not already being used
or
Ceftriaxone (50mg/kg IM or IV for 3 days)

32
Q

AOM - Alternative ABx treatment after 48-72hrs of Failure of Initial Therapy

A

Ceftriaxone 3 days or clindamycin with or without third-get cephalosporin
or
Clindamycin plus third-get cephalosporin. Tympanocentesis