pharmacy first acute otitis media

Question 1

who is inclided in this pharmacy first

Answer 1

children aged 1-17
non pregnant under 16
people who have not had otitis media 3 times or more in the last 6 months OR 4 episodes in the past 12 months

Question 2

what are the red flags we should rule out - end as a refferal to A&E or call 999

Answer 2

Suspected acute complications:
☐ Meningitis (neck stiffness, photophobia, mottled skin)
☐ Mastoiditis (pain, soreness, swelling, tenderness behind the affected ear(s))
☐ Brain abscess (severe headache, confusion or irritability, muscle weakness)
☐ Sinus thrombosis (headache behind or around the eyes)
☐ Facial nerve paralysis

Question 3

symptoms of meningitis

Answer 3

neck stiffness
photophobia
fever
mottled skin

Question 4

what is the inclusion criteria

Answer 4

Does the patient have acute onset of
symptoms including:
☐ In older children— earache
☐ In younger children — holding, tugging,
or rubbing of the ear
☐ In younger children: non-specific
symptoms such as fever, crying, poor
feeding, restlessness, behavioural
changes, cough, or rhinorrhoea

AND
☐ A distinctly red, yellow, or cloudy tympanic
membrane
☐ Moderate to severe bulging of the tympanic
membrane, with loss of normal landmarks and an air
fluid level behind the tympanic membrane
☐ Perforation of the tympanic membrane and/or
sticky discharge in the external auditory canal

Question 5

What are the ither symptoms we should chec for

Answer 5

Does the patient meet ANY of the following criteria:
☐ Patient is systemically very unwell
☐ Patient has signs of a more serious illness
☐ Patient is high risk of complications because of pre-existing comorbidity (this includes children with
significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis and young
children who were born prematurely)

Question 6

what is the ear drops we should offer

Answer 6

WITHOUT perforation

phenaxone with lidocaine
7 day use

+ self care

Question 7

when can patinets return to the pharmacy if the ear drops dont work

Answer 7

3-5 days

Question 8

what abx are associated with otitis media

Answer 8

amoxicillin 5 days
clarithromycin 5 days (if penicillin allergic)
erythromycin 5 days (if pregnant ages 16-17)

Question 9

when can abx be given

Answer 9

symptoms persis longer than 3 days so far OR they are deemed as severe based on professional opinion

Question 10

if the child is over 2 and the infection is in one ear what should we do

Answer 10

mild symptoms = seld care advice
severe/moderate = ear drops