B3-054 - AOM and OME Flashcards
______ is the most common reason for Antibiotic prescriptions in children
Otitis Media
Rates of otitis media are _____
Declining
Why are fewer people visiting the doctors office for OM?
- increased cost of copayments
- increased public education
- use of conjugated pneumococcal vaccine
- increased flu vaccine
- better differentiation between AOM and OME
AOM
Acute Otitis Media
OME
Otitis Media with Effusion
Path of AOM
usually occurs with or following viral upper respirator tract infection (URI)
75% of URI have______
Eustachian tube dysfunction
Breakdown of bacteria/viral distribution of AOM cases
66% - bacterial and viral
27% - bacterial only
4% - viral only
Bacterial culprits of AOM
- Strep. pneumonia
- nontypal Haemaphilus influenza (nTHi)
- Moraxella catarrhalis
- Strep. pyogenes (school age children)
Age distribution of 1st episode of AOM
- 16% 0-6m
- 44% 7-18m
- 40% 19m-2yr
___% of children with OM had more than 4 episodes of AOM
40%
Risk factors for AOM
- day care
- non-hispanic white
- atopy
- siblings
- family history
Symptoms of AOM
- 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
Bulging TM is highly _____, whereas impaired TM mobility is highly _____.
specific; sensitive.
OME path
Often aftermath of AOM or consequence of Eustachian tube dysfunction from URI
Can precede AOM
OME and antibiotics
Should AVOID
AOM diagnosis
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
AOM diagnosis must have ______
Middle ear effusion (MEE)
When is observation treatment an option?
- 6m-2yr non severe, unilateral
- 2+ year, non severe, unilateral
- 2+ year, non severe, bilateral
Drug of choice for AOM
Amoxicillin 80-90mg/kg/day divided bid. Reassess within 48-72 hrs
OME
Fluid in ear, without pain or bulging of TM
Most cases of OME resolve within ___
3 months
____% of children have repeat OME
30-40%
___% of OME episodes last more than 1 year
5-10%
___% of OME last more than 3 months
25%
“Watchful Waiting” protocol
- no ABx, anti-hist, decongestants, or steroids
- After 3m, get a hearing test
Who is at risk for OME
- CMV, downs syndrome, cleft palate, blind
Rough Surgery Guidelines for Tubes
- Less than 4yr: tubes
- 4+ yrs: tubes and/or adenoidectomy
AOM - First Line Treatment for Initial Antibiotic Therapy
Amoxicillin (80-90 mg/kg/day in 2 divided doses)
or
Add clavulanate if pt received amoxicillin within previous 30 days
AOM - First Line Alternative treatment if allergic to PCNs
Cefdiner, Cefuroxime, Cefpodoxime, Ceftriaxone (50mg/kg IM or IV for 3 days)
AOM - ABx treatment after 48-72hrs of Failure of Initial Therapy
Add Clavulanate to amoxicillin if not already being used
or
Ceftriaxone (50mg/kg IM or IV for 3 days)
AOM - Alternative ABx treatment after 48-72hrs of Failure of Initial Therapy
Ceftriaxone 3 days or clindamycin with or without third-get cephalosporin
or
Clindamycin plus third-get cephalosporin. Tympanocentesis
