Acute otitis media: Difference between revisions
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***[[Moraxella]] (30%) | ***[[Moraxella]] (30%) | ||
== | ==Clinical Features== | ||
*Acute onset (<48hr) AND | *Acute onset (<48hr) AND | ||
*Middle ear effusion AND | *Middle ear effusion AND |
Revision as of 18:52, 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
- Mastoiditis
- Brain abscess
- Lemierre's Syndrome
- Herpes zoster oticus
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Management
Analgesia
- Acetaminophen/ibuprofen and topical benzocaine (unless perforated TM)
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
- Amoxicillin 80-90mg/kg/day divided into 2 daily doses 7-10 days
Treatment during prior Month
- 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
- Cefdinir 14mg/kg/day BID x7-10 days
- Cefpodoxime 10mg/kg PO daily x7-10 days
- Cefuroxime 15mg/kg PO BID x7-10 days
- Cefprozil 15mg/kg PO BID x7-10 days
Otitis/Conjunctivitis
- Suggestive of non-typeable H.flu
- 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
- Amoxicillin/Clavulanate
- 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
- Ceftriaxone 50mg/kg IM once as single injection x 3 days
- Use if cannot tolerate PO
Penicillin Allergy
- Azithromycin 10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining days
- Clarithromycin 7.5mg/kg PO BID x 10 days
- Clindamycin 10mg/kg PO three times daily
- Clindamycin does not cover H. influenza and M. catarrhalis and treatment should favor Azithromycin use
Complications
- Mastoiditis
- Meningitis
- Brain Abscess
- Lateral Sinus Thrombosis
See Also
Sources
- ↑ 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.