Lecture 32: Peds Infections

Question 1

What are some of the risk factors for Acute Otitis Media [AOM]?

Answer 1

• Smoke exposure
• Formula feeding
• Vaccines?
• Daycare
• Male
• Family History
• Onset of first episode before 6-12m [higher risk later]

Question 2

What is the difference between Otitis Media with Effusion [OME] and Acute Otits Media [AOM]?

Answer 2

• OME: middle ear sterile; NO infection [NO Anitbiotics]
• AOM: Bacterial infection [YES Antibiotics]

Question 3

Wht is the pathogensis of AOM?

Answer 3

• Poor aration of middle ear causes eusachian dysfunction
• Imflammtion and Edema = narrow eustachian tube
• Trapped air creates reverse vacuum = increased fluid
• Increased fluid = increase bacteria

Question 4

What are some of the common Bacteria within AOM?

Answer 4

• Strep Pneumonia
• H. Fluenzae
• M. Catarrhalis

Question 5

What are some of the clinical manifstations of AOM?

Answer 5

• Ear pain
• Tugging at ear
• Fever
• Irritability
• Not eating
• Ear discharge

Question 6

What is the way that we diagnosis AOM?

Answer 6

• Looking at tympanic membrane
• Noraml TM: convace, gray, moves to pressure
• TM in AOM: Bulging, cloudy, immobile

Question 7

What is the way that we determine the severity of AOM?

Answer 7

• Non-Severe: mild ear pain AND Fever
• Severe: Mod to Severe ear pain OR Fever

Question 8

What is the criteria for just observing AOM or Treating AOM?

Answer 8

• Basically always treat UNLESS its Bilateral for >2yo or Unilateral for > 6m

Question 9

What is the management of AOM?

Fail Observation?

Answer 9

• Observation [no antibiotics for 48-72h, watch, give refild (tylenol or ibprofen for 6m or older)]
• Fail = talk to dr, begin antibiotics

Most do SNAP; where parents are given Rx for antibiotics. if not better in 1-2 days then fill it

Question 10

What medication is considered the First Line for AOM?

What are the advantages of it?

Answer 10

• Amoxicillin 80-90 mg/kg/day divided q12h for 5-10d
• Advantages: overcomes resistance in ear and 4-6h hale life

Question 11

When should we NOT use amoxicillin?

Answer 11

• if resistance
• treatment failure
• Had it within last 30 days
• allergy
• Conjunctivits

Question 12

What is the 2nd line choice if Amoxicillin fails?

Advantages? Disadvantages?

Answer 12

• Augmentin 90 mg/kg/day Amox compenent divided q12h
• Advantages: cover b-lactamase
• Disadvantages: $$$, increased diarrhea

Question 13

What is the way that we determine what strength of Augmentin to use for AOM?

Answer 13

• Mainly use 600mg amox/42.9mg clav/5ml
• ((# amox/day) / Amox part) * Clav part /kg

WANT CLAV under 10mg/kg/day for decreased diarrhea

Question 14

What is the 2nd line agent if there is an allergy to amoxcillin?

Answer 14

• Cefdinir 14mg/kg/day q12h to q24h
• Taste good
• $$$

Question 15

What is the agent taht should be used in severe cases if PO is not an option or other PO treatments fail of OAM?

Advantages? Disadvantages?

Answer 15

• Ceftriaxone 50mg/kg daily IM
• Advantages: broad spec; as good as Amox
• Disavantages: Injection pain, $$, AVOID in < 1m of age, dont give with calcium

Question 16

What are some other alternative agents that might be used in AOM?

Answer 16

• Clindamycin [not good for H. Flu]
• Levo or Linezolid [$$$]
• MACs
• Bactrim [NOT used]

Question 17

What is the duration of treatmetn for a child under 2 years old compares to over 2 years old?

Answer 17

• Under 2: 10 days
• Over 2: 5-7 days [10 days for Severe AOM, TM perforation, < 2yo]

Question 18

What are some of the Adjunctive therapyies that are used for AOM?

Answer 18

• Analgesics [APAP or Ibuprofen (older than 6m tho) –> SHOULD NOT alternate these; Benzocaine Drops]

Question 19

What is a Tympanostomy Tube?

Answer 19

• Small tubes put into the TM to help with drainage
• Mainly for those with reurrent AOM [3 or more in < 6m and 4 or more in < 12m]

Question 20

For those that have Tympanostomy Tubes, what is the treatment for them?

Answer 20

• Oflaxacin or Ciprofloxacin drops for 5-7 days