Otitis Media

Question 0

OM - approach to treatment

Answer 0

1. AOM vs OME
2. Observation +/- Analgesia (Tylenol, Motrin, opioid if severe)
3. Selective use of abx

Prevention - bf and Immunizations

Question 1

OM - common organisms

Answer 1

Strep pneumo (gr + cocci) 25-50%
H. Influenza (gr - bacilli) 15-30%
Moraxella (gr- cocci) 3-20%
Viral 5-22%

Question 2

Diagnosis of AOM requires:

Answer 2

1. Acute s/s
2. middle ear effusion (bulging, maybe drainage)
3. middle ear inflammation

Question 3

OM (severe) - DOC

Answer 3

If mod-severe otalgia and high fever get additional coverage against beta lactamase +, h.influenza and moraxella

Amoxicillin-clavulanate (augmentin) 90 mg/kg/d in 2 divided doses

Question 4

OM - DOC

Answer 4

***Amoxicillin
80-90 mg/kg/d

Sufficient to cover susceptible and intermediate resistant pneumococci, low cost and safe.

Alt. macrolides (Azithro)

Question 5

Duration of treatment - OM

Answer 5

<6 = 10 days
6+ = 5-7 days

Question 6

OM - DOC if PCN allergic

Answer 6

If allergy not anaphylaxis or severe, give a Ceph:
Cefdinir (Omnicef)

If severe allergy:
Azithromycin
Bactrim
Rocephin IM

Question 7

What if AOM does not respond to treatment in 48-72 hours?

Answer 7

If observation –> AMX
If AMX –> AMX-CLA
If AMX-CLA –> Ceftriaxone IM (if N/V) or clindamycin (PCN allergic)

Question 8

OM - prevention

Answer 8

Vaccination - flu, PCV, Hib

Question 9

OME - treatment

Answer 9

No abx

Monitor for hearing loss and/or learning problems (esp if >3 mos)

Question 10

What differentiates AOM from OME?

Answer 10

In AOM, tympanic membrane is inflamed w/possible drainage. Needs abx.

Question 12

Who meets criteria for obs for AOM vs OME?

Answer 12

6 mos - 2 yrs w/ non severe illness AND uncertain diagnosis
>2 yrs no severe illness OR uncertain diagnosis

Obs for 48-72 hrs

Question 13

Which abx can be given as a one time dose if concerned about compliance for OM treatment?

Answer 13

Rocephin IM x 1

Question 14

Why do you use a BLI like CLA (ex. Augmentin) when treating staph?

Answer 14

Because staph make beta-lactamase and strep does not. The BLI protects the abx.