pediatric OM Flashcards
Most common viral causes (~20% of cases)
- respiratory syncytial virus (RSV)
- rhinovirus
- influenza
- adenovirus
Most common bacterial causes ( ~80% of cases)
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Antibiotic resistance trends: S. pneumoniae
42% penicillin non-susceptible
- alteration of penicillin binding protein (PBP)
- affects penicillins, cephalosporins and other beta lactams
Antibiotic resistance trends: H. influenzae
30-50% produce beta lactamase
Antibiotic resistance trends: M. catarrhalis
> 90% produce beta lactamase
Signs and symptoms of AOM
Middle ear effusion
Acute onset of symptoms
- fever
- rhinorrhea
- irritability
- otalgia (ear pain)
- tugging/rubbing ear
Otoscopic exam
- tympanic membrane appears erythematous, cloudy, white, bulging
Acute otitis media definition
rapid onset of signs and symptoms of inflammation in middle ear
Severe AOM definition
AOM with:
- moderate to severe otalgia
OR
- fever > 39 C (102.2F)
Non-severe AOM definition
AOM with:
- mild otalgia
AND
- temperature < 39 C (102.2 F)
Recurrent AOM definition
- > /= 3 well documented separate AOM episodes in the past 6 months
OR - > /= 4 episodes in the past 12 months with >/= 1 episode in the past 6 months
Otitis media with effusion (OME or severe otitis media)
inflammation of middle ear with liquid collected in middle ear, but no signs or symptoms of acute infection
Chronic suppurative otitis media
continuing inflammation of middle ear for at least 6 weeks, leading to perforated tympanic membrane and otorrhea
Diagnostic criteria
- Middle ear effusion (new onset otorrhea not due to acute otitis externa)
AND - acute onset of symptoms (<48 hrs)
Analgesia
Oral
-APAP (10-15 mg/kg PO Q4-6H)
-IBU (>/= 6 months: 10 mg/kg PO Q6-8H
Topical
- Anesthetics (antipyrine, benzocaine, lidocaine)
Naturopathic/Homeopathic ear drops
Antibiotics recommended for children with:
moderate to severe signs/symptoms:
- otalgia >/= 48 hrs
- temp >/= 39 C
Age < 24 months and bilateral AOM
First line antibiotic
Amoxicillin 80-90 mg/kg/d in 2 divided doses
- has not received amoxicillin in bast 30 days
- does not have concurrent purulent conjunctivitis
- is not allergic to penicillin
2nd line
Amox/Clav 90 mg/kg /day in 2 divided doses
- has received amoxicillin in past 30 days
- concurrent purulent conjunctivitis
- Hx of AOM unresponsive to amoxicillin
Alternatives: Penicillin allergy
Non-life threatening: use PO cephalosporin (cefdinir, cefuroxime, cefpodoxime)
Life threatening: macrolide (azithromycin, clarithromycin, clindamycin)
Ceftriaxone 50mg/kg IV x1
Therapy duration
severe or < 2 yo = 10 days
2-5 years w/ mild-mod = 7 days
>6 years w/ mild-mod = 5-7 days
Recurrent AOM treatment
tympanostomy tubes
adenoidectomy
prophylactic abx NOT recommended
