Ear Infections

Question 1

What are the main causative agents in otitis EXTERNA? (2)

Answer 1

1. Staph aureus

2. Pseudomonas

Question 2

What are the main causative agents in otitis MEDIA? (9)

Answer 2

Viruses:

• RSV
• rhinovirus
• adenovirus
• influenza virus
• parainfluenza virus

Bacteria:

• H.influenza
• Strep pneumoniae
• Strep pyogenes
• Moraxella catarrhalis

Question 3

What is the abx of choice for treatment of otitis externa?

Answer 3

FIRST LINE:
- Flucloxacillin (think staph)

SECOND LINE: if penicillin allergy or intolerance
- Macrolide (clarithromycin or azithromycin or erythromycin)

• *If pseudomonas is suspected, give:
• Ciprofloxacin or an aminoglycoside

Question 4

What is the abx of choice for treatment of otitis media in a patient WITHOUT penicillin allergy?

Answer 4

NO PENICILLIN ALLERGY
First line:
- amoxicillin

Second line: worsening symptoms despite 2-3 days of amoxicillin
- co-amoxiclav

Question 5

What is the abx of choice for treatment of otitis MEDIA in a patient with penicillin allergy?

Answer 5

IF PENICILLIN ALLERGY:
First line:
- clarithromycin or erythromycin

Second line: worsening symptoms despite 2-3 days of treatment
- consult local microbiologist

Question 6

What is the route of administration of amoxicillin in treatment of AOM?

Answer 6

Oral (125-500 mg TDS for 5-7 days; dose adjusted to age of child)

Question 7

What is the route of administration of flucloxacillin in the treatment of otitis EXTERNA?

Answer 7

• oral
• IM injection
• slow IV injection
• IV infusion

Question 8

What is the route of administration for ciprofloxacin in the treatment of otitis EXTERNA caused by pseudomonas?

Answer 8

Topical, BD for 7 days