Pediatric ear infections Flashcards
AOM Risk factors
Smoke exposure
Formula feeding
Immunizations
Immune deficiency
Atopy
Daycare attendance
Male, non-white
Family history–>sibling/parent with > 3 episodes
Onset of 1st episode before 6-12 months of age
Lower socioeconomic status
Congenital anomalies
AOM Pathogenesis
Ineffective aeration of middle ear leading to eustachian tube dysfunction–>inflammation & edema of musical linings & narrowing of eustachian tube–> trapped air creates vacuum reversing flow of secretions drawing fluid into middle ear–>bacteria multiply
65-70% of AOM have pathologic bacteria
AOM common pathogens
Streptococcus pneumoniae: 50% of strains resistant to penicillin–> overcome by high dose Amoxicillin
H. influenza: 1/3 cases produce B-lactamase–> overcome by addition of B-lactamase inhibitor (Augmentin)
Moraxella catarrhalis: 3/3 of cases produce B-lactamase–> overcome by addition of B-lactamase inhibitor (Augmentin)
AOM Classification
Otitis media with effusion
- middle ear fluid is sterile–> no antibiotics
Acute otitis media
- bacterial infection–> antibiotics if symptomatic
AOM Presentation
Ear pain: holding/tugging ear
Ear discharge
Fever
Irritability
Poor feeding/anorexia
Disrupted sleep
Malaise
AOM Diagnosis
Visualize tympanic membran TM
Normal TM
- slightly concave
- pearly gray, translucent
- moves in response to pressure
AOM TM
- bulging
- cloudy, purulent
- immobile
Requires acute onset + middle ear effusion + symptoms
AOM Severity
Non-severe
- mild ear pain + fever < 39 C in past 24 hours
Severe
- moderate-severe ear pain + fever fever ≥ 39 C
AOM vaccinations
PCV15, PCV20
Given at 2,4,6,12 months
Takes 5+ years for serotype maturity
Treatment vs Observation (defer for 48-72 hours)
Non-severe
- Unilateral: < 6 months–> TREAT
- Bilateral: < 6 months-2 years–> TREAT
Severe–> TREAT EVERYONE
AOM Prevention
Vaccines: pneumococcal, flu
Reduce risk factors
Prophylaxis: only is ≥ 6 episodes per year
Tubes: if ear discharge with tubes
- topical FQ (ofloxacin, ciprofloxacin) drops
AOM 1st line treatment
Amoxicillin 80-90 mg/kg/day divided q12h x 5-10 days
Advantages: t1/2= 4-6 hours, safe, effective, inexpensive
When to NOT use:
- Resistance
- Allergy
- Treatment failure
- Amoxicillin in last 30 days
- Concurrent conjunctivitis–> AUGMENTIN
AOM 2nd line treatment
Augmentin 90 mg/kg/day divided q12h x 5-10 days
Advantage: Covers B-lactamase-producing organisms
Disadvantage: expensive, more diarrhea with clavulanate
- desire < 10 mg/kg/day
MUST USE 600 mg/42.9 mg/5 mL divided q12h x 5-10 days
Cefpodoxime 10 mg/kg/day divided q12h x 5-10 days
Advantage: better bioavailability, use if B-lactam allergy
Disadvantage: tastes bad
AOM 3rd line treatment
Ceftriaxone 50 mg/kg IM daily
Designated for severe cases when oral treatment fails or is not an option
Advantage: broad spectrum, compliance, effective as 10 day amoxicillin
Disadvantage: injection site pain, cost, AVOID IF < 1 month of age–>Kernicteus
AOM duration of treatment
< 2 years old= 10 days
> 2 years old= 5 days
- unless severe or recurrent AOM, perforation TM
AOM Follow-up
Young infants with severe episode: within days
Children with continuing pain: within days
Infants/young children with recurring: within 2 weeks
Children with sporadic episode: within 1 month
Older children: no follow-up
Adjunct
APAP: 10-15 mg/kg q4-6h (max: 75 mg/kg/day)
Ibuprofen: 5-10 mg/kg q6-8h if older than 6 months
Lidocaine otic drops: do not use in ruptured TM or tubes
Safety-Net Antibiotic Prescription (SNAP)
Parents allow 1-2 days for infection to resolve
If symptoms persist, fill prescription
Chronic Suppurative Otitis Media
Most severe form of otitis media
Perforated TM with persistant drainage lasting > 6 months
Common pathogen: MRSA
Abscess, hearing loss
Tx: Ofloxacin/ciprofloxacin ear drops x 2 weeks
Acute Otitis Externa (Swimmer’s ear)
Limited to external ear canal
Trauma, trapped moisture
Common pathogens: Pseudomonas, staphylococcus aureus, Fungal?
Treatment: Polymyxin B, Neomycin, Ofloxacin, Ciprofloxacin + Hydrocortisone ear drops
