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Copy of Etiology and Treatment of Acute Otitis Media in Children
Transcript of Copy of Etiology and Treatment of Acute Otitis Media in Children
Acute Otitis Media in Children Acute Otitis Media Upper Respiratory Infection
Hallmarks for DX:
***Projection/immobility of the tympanic membrane***
Ear pain (Otalgia) (75%)
Fluid accumulation -->Inflammation of middle ear
Additional DX: (Nonspecific)
Bilateral (50%) Infants/children YES! 80% Adults 20% Daycare attendance
Children 6-18 months
Consider viral URI
Lack of Breastfeeding Major Risk Factors Anatomically, why are infants at a greater risk? Eustachian tubes are shorter and more horizontal risk of entry Streptococcus pneumoniae Our Key Players and Major Culprits Is one patient population more at risk? Mastoiditis
Tympanic Membrane Perforation Complications Treatment Non-RX RX Our Antimicrobial Stewardship Do we give AB at signs/sx or wait 48-72 hours?
Who's a good candidate?
PCV7 Ultimately, want
to minimize antimicrobial resistance APAP/NSAIDS (Ibuprofen)
Expectorants T-Tubes Amoxil:
IM Ceftriaxone (Extreme) Other Alternatives: Goals: Signs/SX
Prevention of complications Must "qualify" No one therapy is superior Often 1st Line:
Time at MIC
Effective Duration of Therapy: ~10-days (consider age)
Diarrhea (@ [ ])
Other Major Considerations?
Recent antibiotic use Otitis Media Infection
What is it?
Who's at risk?
Treatment Options What is it? Haempohilus influenzae (29%)
Moraxella catarrhalis (28%)
Some viruses and
fungi may be
involved too Risk Factors and Occurence 2nd Line Choices: Macrolides Consider use of OTC pain medication
Drawbacks? Vaccination? Treatment Options?
So many choices! Normal Tympanic Membrane AOM (49%) Disclaimer:
This ride may cause motion sickness 1 2 3 80-90mg kg * day Khaliq Y, Forgie S, Zhanel G. Upper Respiratory Tract Infections. In: DiPiro JT, Talbert RL, Yee GC et al., Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York: McGraw-Hill; 2005:1963-75.
Gilbert DN, Moellering, Jr RC, Eliopoulos GM et al. The Sanford Guide to Antimicrobial Therapy 2011. 41st ed. Sperryville: Antimicrobial Therapy, Inc; 2011.
Khaliq Y, Forgie S, Zhanel G. Upper Respiratory Tract Infections. In: DiPiro JT, Talbert RL, Yee GC et al., Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York: McGraw-Hill; 2005:1963-75.
Klein JO, Pelton S. Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications. In: UpToDate [Internet Database]. DS, Basow, eds. Waltham, MA: UpToDate. Updated 2012 May 25.
Klein JO, Pelton S. Acute otitis media in children: Treatment. In: UpToDate [Internet Database]. DS, Basow, eds. Waltham, MA: UpToDate. Updated 2012 Jun. 14. References 90 mg/kg/day AMOX & 6.4 mg/kg/day of CLAV 50 mg/kg x1 (48 h in ear!) Suspension: 30 mg/kg/day (maximum dose:
1 g/day) in 2 divided doses
Tablet: 250 mg every 12 hours Children 6-18 months are at the greatest risk
Cardinal Signs: Otalgia, bulging ear drum and
fluid accumulation in the middle ear
Consider the following before the use of an antibiotic:
Certainty of DX
Amoxil is 1st line, but there are many alternatives Conclusions Considerations: Do you remember which ones they are? Remember "ACE:"
Erythromycin Special thanks to Nicole Hannon