Pediatric Infections: Acute Otitis Media

Question 1

Pathophysiology of AOM

Answer 1

Viral OR bacterial infection of the middle ear
Most common in children 6 – 24 months of age

Question 2

Common bacteria causing AOM

Answer 2

Streptococcus pneumoniae - 90%
Nontypeable Haemophilus influenza - 80%
Moraxella catarrhalis - 60%

Question 3

Diagnosis of AOM

Answer 3

Fever -
< 39ºC (< 102.2ºF) OR > 39ºC (> 102.2ºF)
Tympanic Membrane - Utilize an otoscope to visualize tympanic membrane or “eardrum”
Otalgia - “Ear pain” – can be VERY painful
Infants tend to “tug” on their ear(s)
Otorrhea - Drainage from the middle ear
Can be “pus” like

Question 4

Prevention of AOM

Answer 4

Vaccinations -
PCV13
Influenza
H. influenza

Question 5

How to treat bilateral AOM with mild – moderate symptoms

Answer 5

6 – 23 months = antibiotic therapy
> 24 months = antibiotic therapy OR observation

Question 6

How to treat Unilateral AOM at any age & mild - moderate symptoms

Answer 6

Antibiotic therapy OR observation

Question 7

Which AOM infections are always treated?

Answer 7

AOM at any age + otorrhea
AOM with severe symptoms

Question 8

First line therapy for AOM?

Answer 8

High-dose amoxicillin

Question 9

First line alternative for AOM?

Answer 9

Amoxicillin-clavulanate

Question 10

First line alternative AOM w/ conjunctivitis

Answer 10

Amoxicillin-clavulanate

Question 11

When is high dose amoxicillin contraindicated for AOM?

Answer 11

Amoxicillin was taken in previous 30 days
Concurrent conjunctivitis
Allergy to amoxicillin

Question 12

AOM Duration of treatment?
< 2 years old ORsevere symptoms

Answer 12

10 day course

Question 13

AOM Duration of treatment?
≥ 6 years old with mild – moderate symptoms

Answer 13

5 – 7 day course

Question 14

Duration of treatment?
2 – 5 years old with mild – moderate symptoms

Answer 14

7 day course

Question 15

Acute Otitis Media (AOM)

Answer 15

Rapid onset of signs/symptoms of middle ear infection

Question 16

Uncomplicated AOM

Answer 16

AOM w/o otorrhea

Question 17

Mild - moderate AOM

Answer 17

AOM with mild otalgia AND temperature < 39C (102.2F)

Question 18

Severe AOM

Answer 18

AOM with moderate - severe otalgia OR fever greater than or equal to 39C (102.2F)

Question 19

Severe AOM

Answer 19

AOM with moderate - severe otalgia OR fever greater than or equal to 39C (102.2F)

Question 20

Recurrent AOM

Answer 20

greater than or equal to 3 separate AOM in 6 months OR
greater than or equal to 4 separate AOM in 12 months with greater than or equal to 1 episode in past 6 months