Difference between revisions of "Acute otitis media"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
(Antibiotics)
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*[[Acetaminophen]]/[[ibuprofen]] and topical benzocaine (unless perforated TM)
 
*[[Acetaminophen]]/[[ibuprofen]] and topical benzocaine (unless perforated TM)
 
===[[Antibiotics]]===
 
===[[Antibiotics]]===
{{Table
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===2013 AAP Decision to Treat Guidelines<ref>AAP Clinical Practice Guideline The Diagnosis and Management of Acute Otitis Media http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488.full.pdf </ref>===
|type=class="wikitable "
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{| {{table}}
|title=2013 AAP AOM Guidelines<ref>AAP Clinical Practice Guideline The Diagnosis and Management of Acute Otitis Media http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488.full.pdf </ref>
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| align="center" style="background:#f0f0f0;"|'''Age'''
|hdrs=Age!!Otorrhea!!Severe Symptoms (unilateral or bilateral)!!Bilateral with out Otorrhea!!Unilateral with out Otorrhea
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| align="center" style="background:#f0f0f0;"|'''Otorrhea'''
|row1=6mo-2y{{!!}}Antibiotics{{!!}}Antibiotics{{!!}}Antibiotics{{!!}}Antibiotics
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| align="center" style="background:#f0f0f0;"|'''Severe Symptoms (unilateral or bilateral)'''
|row2=≥2y{{!!}}Antibiotics{{!!}}Antibiotics{{!!}}Antibiotics or observation period{{!!}}Antibiotics or observation period
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| align="center" style="background:#f0f0f0;"|'''Bilateral with out Otorrhea'''
}}
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| align="center" style="background:#f0f0f0;"|'''Unilateral with out Otorrhea'''
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|-
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| 6mo-2y||Antibiotics||Antibiotics||Antibiotics||Antibiotics
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|-
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| 2=≥2y||Antibiotics||Antibiotics||Antibiotics or observation period||Antibiotics or observation period
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|}
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'''Also Consider In:'''
 
'''Also Consider In:'''
 
*Age <6mo
 
*Age <6mo

Revision as of 08:20, 16 October 2016

Background

  • Peak incidence: 6-18 months of age

Etiology

Clinical Features

A bulging tympanic membrane which is typical in a case of acute otitis media
  • Acute onset (<48hr) AND
  • Middle ear effusion AND
  • Signs of middle ear inflammation
    • Middle Ear Effusion: bulging TM, impaired TM movement, otorrhea, or air/fluid level
    • Middle Ear inflammation: erythema of TM or otalgia

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Less common

Pediatric fever

Evaluation

  • Typically clinical

Management

Analgesia

Antibiotics

2013 AAP Decision to Treat Guidelines[1]

Age Otorrhea Severe Symptoms (unilateral or bilateral) Bilateral with out Otorrhea Unilateral with out Otorrhea
6mo-2y Antibiotics Antibiotics Antibiotics Antibiotics
2=≥2y Antibiotics Antibiotics Antibiotics or observation period Antibiotics or observation period

Also Consider In:

  • Age <6mo
  • Ill-appearing
  • Recurrent acute otitis media (within 2-4wk)
  • Concurrent antibiotic treatment
  • Other bacterial infections
  • Immunocompromised
  • Craniofacial abnormalities

Wait-and-see antibiotic prescription (WASP)

  • Rather that routine perscription is an option to avoid over use if the patient does not meet any of the prescription criteria[2]
  • If symptoms worsen or persist for 48-72 then caretaker fill the prescription
  • Fever (relative risk [RR], 2.95; 95% confidence interval [CI], 1.75 - 4.99; P<.001) and otalgia (RR, 1.62; 95% CI, 1.26 - 2.03; P<.001) were associated with filling the prescription in the WASP group

Antibiotics Options

Initial Treatment

  1. Amoxicillin 80-90mg/kg/day divided into 2 daily doses 7-10 days

Treatment during prior Month

  1. If amoxicillin taken in past 30 days, Amoxicillin/Clavulanate
    • 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
    • Clavulanate increases vomiting/diarrhea
  2. Cefdinir 14mg/kg/day BID x7-10 days
  3. Cefpodoxime 10mg/kg PO daily x7-10 days
  4. Cefuroxime 15mg/kg PO BID x7-10 days
  5. Cefprozil 15mg/kg PO BID x7-10 days

Otitis/Conjunctivitis

  • Suggestive of non-typeable H.flu
  1. Amoxicillin/Clavulanate
    • 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
    • Clavulanate increases vomiting/diarrhea

Treatment Failure

defined as treatment during the prior 7-10 days

  1. Amoxicillin/Clavulanate
    • 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
  2. Ceftriaxone 50mg/kg IM once as single injection x 3 days
    • Use if cannot tolerate PO

Penicillin Allergy

  1. Azithromycin 10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining days
  2. Clarithromycin 7.5mg/kg PO BID x 10 days
  3. Clindamycin 10mg/kg PO three times daily

Complications

See Also

References

  1. AAP Clinical Practice Guideline The Diagnosis and Management of Acute Otitis Media http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488.full.pdf
  2. Spiro DM. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA. 2006 Sep 13;296(10):1235-41.