Otitis Media Flashcards
When do you give antibiotics for OM
•Patient is below 6 months
•Aboriginal or Torres Strait Islander children
•Cochlear implant
•Suppurative problem
•Only hearing ear
•Immunocompromised
Since OM is self resolving without antibiotics, what pain meds would you give?
•Paracetamol 125/5ml TID PRN
•2% Lignocaine drops (1-2) to INTACT eardrum
What antibiotics are recommended and when are they necessary?
•Ciprofloxacin drops if cochlear implant
•Amoxycillin 80mg/kg BID 5/7- if NO antibiotic in last 30days, NO concurrent purulent conjunctivitis, NO penicillin allergy
• Amoxi-clavulanate 90/6.4mg/kg if penicillin resistance, aboriginal or had amoxycillin in last 30 days
• Ceftriaxone 50mg/kg IM 3/7 OR Clindamycin 30mg/kg TID if initial antibiotic failure after 48-72 hrs
What delayed and immediate therapy would you recommend in cases of penicillin allergy
Delayed-Cefuroxime 10mg/kg BID 5/7 if between 3 months and 2 yrs
Immediate- Cotrimoxazole 4/20mg/kg BID 5/7 if older than 1month
If one fails to perform tympanocentesis; how would you cover for Haemophilus influenzae
• Clindamycin +/- Cefixime
Antihistamines and decongestants are unnecessary in treatment of AOM. When are corticosteroids indicated?
• Chronic middle ear effusion
How do you treat OME after antibiotic failure?
•Surgical intervention
-tympanostomy tubes to equalize pressure and drain middle ear
You’re doing great!
Keep going, you’ll be fine
What are the indications for tympanostomy tubes? (include Complications)
•Persistent middle ear effusion for more than 3 months
•Failure of antibiotic therapy
•Recurrent (more than 3 episodes in 6months)
•4 or more episodes in 12 months
COMPLICATIONS
•Associated with hearing loss
•Acute mastoiditis
•impending intracranial complication
What’s the difference between a mild and severe penicillin allergy? How would you treat this patient?
Mild-rash
•Cephalosporin- Cefuroxime 10mg/kg BID 3/7 if 3mnths-2yrs
Severe- anaphylaxis
Give macrolide
•Clindamycin
•Azithromycin
•Clarithomycin
•
What scale is used for AOM diagnosis
AOM- Severity of Symptoms (AOM-SOS)
•tugg at ears (2)
•increased crying (2)
•irritability
•disturbed sleep (2)
•diminished activity
•diminished appetite
•fever