CPG ON ACUTE OTITIS MEDIA (AB) Flashcards
Who are the Philippine Clinical Practice Guidelines for Acute Otitis Media in Children intended for?
PSO-HNS and children aged 2-12 years
What are the objectives of the Philippine Clinical Practice Guidelines for Acute Otitis Media in Children?
- To emphasize requisites for diagnosis of AOM in children\n2. To describe treatment options based on current evidence
Which sources were used to develop the guidelines for Acute Otitis Media in children?
National Guideline ClearingHouse, Society for Middle Ear Disease Organization, Cochrane Ear, Nose and Throat Disorders Group of NIHR
What additional search strategies were used for developing AOM guidelines?
Electronic databases (Cochrane, Medline, PubMed, ScienceDirect, etc.), local libraries, search for unpublished literature (19,653 articles)
How many articles were chosen as the foundation for the Clinical Practice Guidelines for AOM?
Total of 45 articles
What is the definition of acute otitis media (AOM)?
Acute middle ear inflammation characterized by signs and symptoms of middle ear inflammation with or without effusion lasting less than 3 weeks
What are the most common bacterial pathogens causing AOM?
S. pneumoniae (25-50%), H. influenzae (15-30%), M. catarrhalis (3-20%)
Which viral pathogens are associated with AOM?
RSV, Rhinovirus, Coronavirus, Parainfluenza, Adenovirus (most common), Enterovirus
What are the stages in the natural history of AOM?
- Hyperemia/Retraction\n2. Exudation\n3. Suppuration/Perforation\n4. Coalescence & Surgical Mastoiditis\n5. Complication\n6. Resolution
What characterizes the stage of hyperemia/retraction in AOM?
Generalized hyperemia of mucoperiosteum, mild earache, ear fullness, fever, erythematous & markedly retracted eardrum on otoscopy
What characterizes the stage of exudation in AOM?
Outpouring of fluid from capillaries, pain, fever, red and thickened bulging eardrum with loss of light reflex
What characterizes the stage of suppuration/perforation in AOM?
Eardrum rupture, severe pain and fever, hearing loss worsens due to tympanic membrane perforation, pressure relieved
What are the risk factors for AOM?
Non-modifiable: age, sex, race, genetics\nModifiable: smoke exposure, low SES, crowded living, daycare, previous antibiotic use, bottle feeding, pacifier use
What additional host-related factors increase the risk of AOM?
Prematurity, allergies, immunodeficiency, cleft palate, craniofacial abnormalities, adenoid hypertrophy, seasonal changes
What is the main basis for diagnosing acute otitis media?
Clinical parameters including history, otoscopy, and pneumatic otoscopy (Grade B Recommendation, Level 3A Evidence)
What are the key diagnostic criteria for AOM?
- History of acute onset (within 3 weeks)\n2. Signs & symptoms of middle ear inflammation\n3. Presence of middle ear effusion
What is the best predictor of AOM based on otoscopic findings?
Limited or absent mobility of the tympanic membrane (high sensitivity 95%, specificity 85%)
What are other otoscopic findings suggestive of AOM?
Cloudiness of tympanic membrane, bulging tympanic membrane, retracted tympanic membrane, erythema, air-fluid level, perforation with otorrhea
What symptoms suggest otalgia in children with AOM?
Older children: rapid onset ear pain\nYoung preverbal children: ear tugging, rubbing, holding\nSubtle signs: excessive crying, sleep disturbances
What is the role of fever in diagnosing AOM?
Fever supports AOM diagnosis but is nonspecific (sensitivity 54%, specificity 82%). Fever >39°C for >48 hrs suggests moderate to severe AOM
What tool is recommended for diagnosing middle ear effusion in AOM?
Pneumatic otoscopy (70-90% sensitivity and specificity)
What is the role of tympanometry in AOM diagnosis?
Not routinely recommended, but can help assess tympanic membrane compliance and perforation if needed (Grade C Recommendation, Level 2B Evidence)
What is the role of tympanocentesis in AOM diagnosis?
Not routinely recommended; bacterial culture is gold standard for bacteremia but not for AOM diagnosis (Grade C Recommendation, Level 2B Evidence)
What is the recommended approach for pain relief in Acute Otitis Media (AOM)?
Pain should be addressed within the first 24 hours upon diagnosis using Paracetamol (10-15 mg/kg/dose) or Ibuprofen (5-10 mg/kg/dose).
When is initial observation an option for AOM?
For children ≥2 years with mild symptoms and for infants 6-23 months with unilateral mild AOM.
What is the recommended course of action for initial observation in AOM?
Defer antibacterial treatment for 48-72 hours while providing symptomatic relief; a mutual decision between parent and physician.
What is a Safety Net Antibiotic Prescription (SNAP) in AOM?
An antibiotic prescription given to parents to use only if symptoms persist or worsen after 48-72 hours.
When should initial antibiotic therapy be prescribed for AOM?
For children ≥6 months with severe symptoms (unilateral or bilateral) and for children <2 years with bilateral disease without severe symptoms.
What is the treatment recommendation for AOM in children <6 months?
Antibacterial treatment for both mild and moderate/severe cases.
What is the treatment recommendation for AOM in children 6 months to 2 years?
Antibacterial treatment for moderate/severe AOM; for mild AOM, antibiotics for bilateral cases and observation for unilateral cases.
What is the treatment recommendation for AOM in children ≥2 years?
Antibacterial treatment for moderate/severe AOM; observation for mild AOM.
What is the first-line antibiotic treatment for mild AOM?
High-dose Amoxicillin (80-100 mg/kg/day in 2 divided doses).
Why is high-dose Amoxicillin recommended for AOM?
It inhibits most non-susceptible strains of pneumococci and achieves adequate drug concentration in middle ear fluid.
What is the first-line antibiotic treatment for severe AOM or treatment failure?
Amoxicillin-Clavulanic acid (90 mg/kg/day Amoxicillin + 6.4 mg/kg/day Clavulanic acid).
When should antibiotic therapy be changed in AOM?
If there is no resolution of symptoms after 3 days, shift to an antibiotic with β-lactamase activity.
What is an alternative treatment for AOM in patients allergic to Amoxicillin?
Clindamycin (30 mg/kg/day TID), single-dose parenteral Ceftriaxone (50 mg/kg), or a 5-day single-dose Azithromycin regimen.
What is the preferred antibiotic for β-lactamase-producing H. influenzae and M. catarrhalis in AOM?
Cefixime, though it has weaker activity against S. pneumoniae.
What are the Type I Hypersensitivity alternatives for AOM?
Azithromycin, Clarithromycin, Erythromycin, or Sulfamethoxazole-Trimethoprim.
What are the Non-Type I Hypersensitivity alternatives for AOM?
Cefdinir, Cefpodoxime, Cefuroxime, or Cefixime.
What is the recommended duration of antibiotic treatment for AOM?
10-14 days for younger than 2 years, 7 days for 2-5 years, and 5-7 days for 6 years and older.
When should clinicians reassess AOM patients after starting treatment?
If symptoms worsen or fail to improve within 48-72 hours.
What are the management options if an AOM patient fails to respond to initial observation?
Initiate antibacterial therapy.
What are the management options if an AOM patient fails to respond to initial antibiotics?
Change antibiotics, consider tympanocentesis or myringotomy, and reassess for complications.
What are the criteria for a positive response to AOM treatment?
Defervescence within 48-72 hours, decreased irritability, normalization of sleep and eating patterns.
What procedures may provide immediate pain relief for AOM?
Tympanocentesis or Myringotomy.
What are the first-line antibiotics for AOM treatment failure after 48-72 hours?
Amoxicillin-Clavulanate (90 mg/kg/day) or Ceftriaxone (50 mg/kg IV/IM for 3 days).
What are alternative treatments for AOM treatment failure?
Ceftriaxone for 3 days, Clindamycin (30 mg/kg/day) ± a third-generation cephalosporin, tympanocentesis, or specialist consultation.
Are antihistamines and decongestants recommended for AOM?
No, they are not recommended for AOM treatment but may be used for concomitant conditions like allergies.
What is the role of pneumococcal conjugate vaccines in AOM?
They reduce the incidence of Otitis Media by preventing upper respiratory tract infections.
How effective is the influenza vaccine in preventing AOM?
It reduces AOM incidence by 30-55%, with an 83% efficacy against influenza-associated AOM in children 7-50 months old.
What is the recommendation regarding breastfeeding for AOM prevention?
Exclusive breastfeeding for at least 6 months reduces AOM incidence by up to 50%.
What are key prevention strategies for reducing AOM risk?
Vaccination, breastfeeding, personal hygiene, avoiding overcrowding, reducing exposure to smoke, and improving socioeconomic status.
Are probiotics recommended for preventing AOM?
No, probiotics are not recommended for AOM prevention.
