Otitis Media Flashcards
AOM in Children vs Adults
More common in Children because their Eustachian Tube is smaller and more horizontal
- Harder for bacteria to drain, and more easy for ear to get plugged
Eustachian Tube: Connects back of throat and middle ear
Otitis Media
- Predisposing Factors
- Common Cold
- Daycare Attendance
- Short Duration of Breastfeeding
- Supine Bottle Feeding (Hard to drain ear)
- Pacifier Use if older than 6 months
How long should a baby be breastfeed
At least for the first 6 months
- Can breastfeed even after the 1st year
Otitis Media
- Symptoms
Pain and ear ache (Tugging at ears)
Fever (40.5 or higher)
Irritability
Night Restlessness
Acute Otitis Media
- 2 Requirements
Inflammation of Middle Ear
Fluid of the Middle Ear
Bacterial Otitis Media
- Presentation
- Cloudy Inflamed Ear Drum
- Purulent fluid
- Decreased mobility of tympanic membrane on pneumotoscopy
Otitis Media With Effusion
AKA Serious Otitis Media
- Fluid in middle ear without symptoms of acute inflammation of the ear
Spontaneous Resolution
S. Pneumoniae ahs the lowest spontaneous resolution rate
- Also has the most serious complication
What is Watchful Waiting
Most cases of Acute Otitis Media resolve on their own
- Treat symptomatically for 48-72 hours and assure follow up
- If symptoms worse or patient does not respond to symptomatic treatment then treat with antibiotics
Watchful Waiting
- Treatments
Treat symptomatically
- Acetaminophen, Ibuprofen
- If allergies are playing a role (Antihistamine, Decongestant)
When not to initiate Watchful Waiting
- Patient is younger than 6 months
- Fever is over 39°C even with antipyretic use
- Severe ear pain
Child is:
- Immunodeficient
- History of cardiac or pulmonary disease
- Anatomically abnormal head or neck
- History of complicated otitis media
- Has perforated ear drums
- Unable to follow up the next day
- Parents are not capable of recognizing worsening symptoms
- Illness becomes worse
Activity Against S. Pneumoniae
Amoxicillin / Ampicillin > Cefuroxime > Cefprozil > Cefixime > Cephalexin
- Cefixime and Cephalexin not recommended if S. pneumoniae resistance is suspected
Acute Otitis Media (No Allergies)
- Treatment of Healthy Child / Not High Risk
1) Is there Purulent Conjunctivitis
Yes: Treat for H. Influenzae
No: Treat for S. pneumoniae
2) Recent Anti-bacterial use within last 3 months or <2 years of age or Daycare
Yes: Risk of S. Pneumoniae resistance
No: Little risk of resistance
Not High Risk, No Allergy
- H. Influenzae Treatment
Amox/Clauv 7:1
- 45 mg/kg/day divided by bid
Not High Risk, No Allergy
- S. Pneumoniae Treatment
Amoxicillin
- 40 mg/kg/day divided by tid
Not High Risk, No Allergy
- S. Pneumoniae Resistance Treatment
Amoxicillin
- 90 mg/kg/day divided by tid
Acute Otitis Media (Beta-Lactam Allergy)
- Treatment of Healthy Child / Not High Risk
1) Severe Type 1 Allergy
Yes: Older than 8 Years Old or Local Resistance less than 20%?
- Doxycycline
- TMP/SMX
No: Younger than 8 Years Old?
- Clindamycin (Has S. pne coverage) + Cefixime (No S.pne coverage)
- Cefuroxime (Has S. pne coverage)
Local Resistance Greater than 20%?
- Levofloxacin
Acute Otitis Media - No Allergy
- Treatment Failure with Amox 40mg/kg/day treatment
Amox 45mg/kg/day + Amox/Clav 7:1 45mg/kg/day
Rationale: Treatment failure could be because of resistant S. Pneumoniae or H. Influenzae
- Use Clav for H. influenzae
- Use amox with clav to simulate high dose amox for resistant S. Pneumoniae
Acute Otitis Media - No Allergy
- Treatment Failure with Amox 90mg/kg/day treatment
Amox/Clav 45mg/kg/day divided bid
Rationale: Amox didn’t work, likely H. Influenzae. Use different mechanism
Acute Otitis Media - Beta-Lactam Allergy
- Treatment failure (Allergy not Severe)
Clindamycin + Cefixime
Ceftriaxone
Acute Otitis Media - Beta-Lactam Allergy
- Treatment failure (Severe Allergy)
Levofloxacin
Otitis Media
- Red Flags
- Facial Paralysis
- Mastoiditis
- Vertigo
What Pathogens cause Otitis Media
- S. Pneumoniae
- M. Catarrhalis
- H. Influenzae
- Group A S. Aureus
Role of Fever
- They do not cause brain damage (Only very high fevers above 42 degrees do)
- Severity of infection and Fever’s response to medication is not related
- Fevers are not always bad
Fever is the bodies way of fighting off infections
- Keep the child comfortable
