PEDs infectious diseases- AOM Flashcards
AOM risk factors
-smoke exposure
-formula feeding
-immunization status
-atopy
-daycare attendance
-male gender
-family history
-onset of first episode before 6-12 months of age - earlier = higher risk
-lower socioeconomic status
-race - non hispanic and non-white kids are at greater risk
- congenital anomalies
- immune deficiency
Classification of
Otitis media with effusion
and
Acute otitis media
OME
- middle ear fluid is sterile; no signs of acute infection
-Antibiotics not indicated
AOM
- bacterial infetion likely
- antibiotics indicated if symptomatic
Causative pathogens for AOM
Never getting cultures here
Streptococcus pneumoniae
H. flu
Moraxella
streptococcus pyogenes
less common organisms
- staph
- gram negative organisms
Clinical manifestation of AOM
Otalgia (ear pain)
Holding or tugging at ear
fever
irritability
poor feeding/anorexia
disrupted sleep
malaise
otorrhea
sometimes asymptomatic
Diagnosis of AOM
visualize tympanic membrane
- usually concaved and pearly gray in color but in presence of AOM it is buldging, cloudy or purulent effusion, immobile
Acute onset, middle ear effusion, symptoms of middle ear inflammation
Severity of AOM
Non severe
mild otalgia and fever < 39 in past 24 hours
Severe
moderate to severe otalgia and fever > or equal to 39
when to know to treat based on age for AOM
If it is severe bilateral or unilateral - all ages will be treated
if puse is present bilateral or unilateral - all ages will be treated
If non severe bilateral ages <6months and 6M to 2 years will be treated (ages 2 and up observe option)
if nonsevere unilateral if age < 6 months treat but 6M and up we will do observe option
Observation in AOM
deferement of antibiotics for 48-72 hours
watch for resolution of symptoms
can provide symptomatic relief like Motrin
Can provide a Saftey net antibiotic prescription SNAP and tell patient wait 1-2 days to fill and if symptoms persist or worsen after 1-2 days of waititng fill script (only used when 2 and up age with nonsevere bilateral and 6M and up with nonsevere unilateral)
Treatment of AOM
First line
Amoxicillin high dose
80-90mg/kg/day divided Q12H x 5-10 days
Second line Augmentin
If allergy
Cefpodoxime 10mg/kg/day divided Q12H (taste really bad)
Tx for severe cases/ oral treatment fails
- Ceftriaxone - 50mg/kg IM x 1 dose
Alternative agents
clindamycin 30-40mg/kg/day divided TID
Levofloxacin or linezolid: very expensive, can lead to collateral resistance
When to not use amoxicillin for AOM - EXAM Q
Known resistance
treatment failure - use augmentin
amoxicillin in last 30 days - use augmentin
allergy - use Cefpodoxime 10mg/kg/day divided Q12H (taste really bad), TMP/SMX (would not recommend)
concurrent conjunctivitis - use augmentin
Amoxicillin Clavulanate use in AOM
2nd line if amoxicillin failure
1st line if amoxicillin was used in last 30 days or conjunctivitis
Dose - 90mg/kg/day amox component divided Q12H
ALWAYS USE THE ES 600mg amox/42.9mg clav/5ml (want clavulanate under 10mg/kg/day because any higher increase risk of diarrhea)
Duration and follow up of AOM treatment for children
under 2 and over 2
Under 2 - 10 days
Over 2 - 5-7 days but 10 days in severe or recurrent AOM
Follow up withing 2 weeks for infants or young children with history of recurrence
no follow up necessary for older children
Adjunctive therapy for AOM
APAP PO 10-15 mg/kg/dose Q4-6H (max 75mg/kg/day)
Ibuprofen PO 5-10mg/kg/dose Q6-8H if older than 6 months
Tympanostomy tubes
small ventilation tubes inserted through TM to provide drainage for eustachian tubes
Indicated in recurrent AOM
3 or more episodes in <6 months
4 or more episodes in <12 months
Tympanostomy tubes and treatment of uncomplicated otorrhea
Oflaxacin, ciprofloxacin drops 4-5 drops in affected ear BID x 5-7 days
Chronic suppurative otitis media
what is it and what is the treatment
perforated TM w/ persistent drainage lasing >6 weeks
MRSA common isolate
can result in hearing loss
Initial treatment
ofloxacin or cipro ear drops x 2 weeks
if treatment failure - culture is indicated (might need IV therapy)
Acute otitis externa (swimmers ear)
Can be caused by trauma or trapped moisture
organisms common: pseudomonas, s. aureus; consider fungal if no improvement
Treatment with ear drops first; Polymixin B, neomycin hydrocortisone
Ofloxacin
Cirpofloxacin with hydrocortisone
