Acute otitis media

Revision as of 18:57, 18 June 2014 by Ostermayer (talk | contribs) (Management)

Background

  • Peak incidence: 6-18 months of age
  • Etiology
    • Viral (70% of cases)
    • Bacterial
      • S. pneumo (50%)
      • Nontypable H. flu (30%)
      • Moraxella (30%)

Diagnosis

  1. Acute onset (<48hr) AND
  2. Middle ear effusion AND
  3. Signs of middle ear inflammation
  4. Notes
    1. Middle Ear Effusion: bulging TM, impaired TM movement, otorrhea, or air/fluid level
    2. Middle Ear inflammation: erythema of TM or otalgia

DDX

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

Management

  1. Analgesia
    1. Acetaminophen/ibuprofen and topical benzocaine (unless perforated TM)
  2. Antibiotics (See also AAP Guidelines below)
    1. Indications:
      1. Age <6mo
      2. Ill-appearing
      3. Recurrent acute otitis media (w/in 2-4wk)
      4. Concurrent abx tx
      5. Other bacterial infections
      6. Immunocompromised
      7. Craniofacial abnormalities
    2. Wait-and-see antibiotic prescription
      1. If symptoms worsen or persist x48-72 then family fills the Rx

Antibiotics

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

AAP Guidelines[1]

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Complications

  1. Mastoiditis
  2. Meningitis
  3. Brain Abscess
  4. Lateral Sinus Thrombosis

See Also

Otitis Externa

Sources

  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
  • Tintinalli