Difference between revisions of "Acute otitis media"

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==Complications==
 
==Complications==
#[[Mastoiditis]]
+
*[[Mastoiditis]]
#[[Meningitis]]
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*[[Meningitis]]
#[[Brain Abscess]]
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*[[Brain Abscess]]
#Lateral Sinus Thrombosis
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*Lateral Sinus Thrombosis
  
 
==See Also==
 
==See Also==

Revision as of 18:53, 26 May 2015

Background

  • Peak incidence: 6-18 months of age
  • Etiology

Clinical Features

  • 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

Common

  • Acute otitis media
  • Chronic otitis media
  • Serous otitis media
  • Foreign body in external ear canal
  • Otitis externa

Less common

  • Accidental trauma
  • Oral cavity disease (referred pain)
  • Cholesteatoma
  • PTA

Rare

Ear Diagnoses

External

Internal

Inner/vestibular

Diagnosis

  • Typically clinical

Management

Analgesia

Antibiotics

class="wikitable" Also Consider In:

  • Age <6mo
  • Ill-appearing
  • Recurrent acute otitis media (w/in 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[1]
  • 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. 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.