Acute Otitis Media - CPS Statement

Question 1

What are the CPS risk factors for AOM? Hint: there are nine!

Answer 1

1) Young age & frequent contact with other children
2) Craniofacial abnormalities
3) Household crowding
4) Exposure to cigarette smoke
5) Pacifier use
6) Shorter duration of BF
7) Prolonged bottle feeding while lying down
8) Family history of AOM
9) Children of Inuit or First Nations ethnicity

Question 2

What are the bacteria most commonly associated with AOM?

Answer 2

1) S. pneumonia
2) H. influenzae
3) M. catarrhalis

Less commonly: GAS

Question 3

Complicated AOM can lead to what cranial nerve palsies?

Answer 3

Cranial nerve VII (facial) - associated with temporal bone inflammation

Cranial nerve VI (abducens) - failure of ipsilateral eye abduction due to petrous bone inflammation or infection (Gradenigo’s syndrome)

Question 4

You see a child with perforated TM with purulent drainage. How long do you treat for?

Answer 4

10 days

Question 5

You see a child with MEE and bulging TM who is MODERATELY ill (irritable, difficulty sleeping, febrile >T39, more than 48 hrs of symptoms). What do you do?

Answer 5

Treat with 10 days of antibiotics if 6 months to two years, 5 days if over 2 years

Question 6

You see a child with MEE and bulging TM who is MILDLY ill (alert, responsive, fever <39, <48 hrs of illness). What do you do?

Answer 6

Observe for 24-48hrs with follow-up, recommend analgesia. If not improving, treat with 10 days of antibiotics if 6 months to two years, 5 days if over 2 years.

Question 7

You see a child without MEE, or with MEE but non-bulging or mildly erythematous TM. What do you do?

Answer 7

Consider viral infection, R/A in 24 - 48 hrs to re-assess for presence of MEE and bulging TM

Question 8

What is the first line antibiotic for AOM? What dose is recommended?

Answer 8

Amoxicillin
TID with 45 - 60 mg/kg/day
BID with 65 - 90 mg/kg/day

Question 9

You see a child with AOM and purulent conjunctivitis. What is your antibiotic choice?

Answer 9

Amox-clav (more likely to be M catarrhalis or H. influenzae)

Question 10

You have a child with a previous reaction to amoxicillin but need to treat their AOM. What do you use instead?

Answer 10

If reaction was not life-threatening - use cefprozil or 3rd gen cephalosporin (CTX 50 mg/kg daily x3 days)

Other options include azithromycin or clindamycin (less effective)

Question 11

How long should it take to recover from AOM?

Answer 11

Symptoms should improve within 24 hr and resolve within 2-3 days