B3.054 - Big Case Otitis Media Flashcards
what is the most common condition for which antimicrobials are prescribed for children in the US
otitis media
Otitis media usually occurs coincident with or following what
viral upper respiratory infection
what occurs in 75% of children with a viral URI to contribute to otitis media
eustatian tube dysfunction, organisms can get transmitted from nasopharynx to the ear
describe the nature of bacterial infections and which are most common
66% bacteria and viruses together 27% bacteria alone 4% viruses alone
what are the 4 most common causes of bacterial Otitis media
strep pneumo non typable H. influenzae strep pyogens moraxella vatarrhalis
what is usually responsible for otitis conjuctivitis
NTHi
whats the difference between prevnar 7 and 13
7 has 7 serotypes and 13 has 13 serotypes
what are factors that increase risk of otitis media
attending daycare white race having siblings family history
what effect does breastfeeding have on AOM
protective
what does “strong recommendation” mean?
you should probably do it
what does it mean if a treatment is an “option”
it should be discussed with patient, hasn’t been definitively proven to be better
what has the greatest specificity and positive predictive value for otitis media
bulging tympanic membrane
most appropriate treatment for otitis media
amoxicillin
what is amoxicillin/clavulonate used for
otitis media thats resistant to penicillins
do you treat otitis media with effusion with antibiotics
no
what do you do for pts with otitis media with effusion
observation
symptoms of AOM
rapid onset ear pain in preverbal children rubbing/tugging ear changes in childs sleep or behavior
best predictor of AOM
cloudy, bulging TM with impaired mobility
which sign of AOM had the highest sensitivity and specificity
impaired mobility
which sign of AOM had the highest specificity but lower sensitivity
bulging
do you use antibiotics for OME
no it doesnt benefit from it
clinicians should not diagnose AOM in children who do not have what
Middle ear effusion
what do you need to make sure you have when doing a tympanometry
a seal
what indicates a presence of MEE
bulging of tympanic membrane limited or absent mobility of the tympanic membrane air-fluid level behind membrane otorrhea
normal tympanic membrane
retracted tympanic membrane
retracted tympanic membrane with air bubbles
what is considered an option for uncomplicated AOM based on age, illness severity, assurance of follow up
observation without use of antimibrobial agents
when do you use a safety net antibiotic
use of safety net antibiotic prescription if not improved at 48 to 72 hours
what is the antibiotic prescribed for most children for AOM
amoxicillin
when do you prescribe an antibiotic with additional beta lactamase coverage
if the child has received amoxicillin in the past 30 days or has purulent conjuctivitis, or is unresponsive to amoxicillin
what do you do for a pneumococcal infection
increase dose, dont need a beta lactamase
if a patient has a penicillin allergy what do you prescribe
ceftriaxone or
cefdiner or
cefpodoxime or
cefuroxime
how is OME defined
presence of fluid in the middle ear without signs or symptoms of acute ear infection
how does peristent OME affect the pt
decreased mobility of the tympanic membrane and serves as a barrier to sound conduction
when do you use pneumatic otoscopy
should be used to document OME
in a child with otalgia, hearing loss, both
suspected OME
when should clinicians get a hearing test
if OME persists over 3 months
what population is more likely to have risk factors for OME
developmental difficulties
