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26 Cards in this Set
- Front
- Back
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8 risk factors for acute otitis media
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a. Children
b. Genetic predisposition c. Premature birth d. Male gender e. Native American / Inuit ethnicity f. Family history of recurrent AOM g. Siblings in household h. Low socioeconomic status |
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certain diagnosis of AOM
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ALL 3
-acute onset of S/Sx -middle ear effusion -S/Sx of middle-ear inflammation |
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describe S/Sx of AOM
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1. Otalgia (tugging on ear)
2. Irritability 3. Otorrhea (defining) 4. Fever >38 C or >100.4 F |
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describe middle-ear effusion
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Fluid accumulation behind tympanic membrane
Indicated by a. Bulging TM b. Limited mobility of TM c. Air-fluid level of TM d. Otorrhea (from rupture of TM) |
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describe S/Sx of middle-ear inflammation
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1. Erythema of TM, but this is also caused by crying
2. Opacification/cloudiness of TM 3. Otalgia |
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define non-severe AOM
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T <39 C and non-severe otalgia
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define severe AOM
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T >39 and/or severe otalgia
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define recurrent AOM
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>3 episodes in 6 months
OR >4 episodes in 12 months |
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define OME
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Fluid in middle ear without S/Sx of acute infection
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3 LT complications of OME
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permanent hearing loss
scarring of TM speech/language delays |
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3 common bacterial pathogens in AOM
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S. pneumoniae
H. influenzae M. catarrhalis |
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describe S. pneumoniae
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1. G+ cocci in chains
2. Resistance to PCNs/cephs due to altered PBPs (NOT B-lactamases) 3. Increase doses to overcome intermediate resistance |
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describe H. influenzae
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1. G – bacilli
2. 50% B-lactamase producing for resistance 3. Resistance can be overcome with a BLI |
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describe M. catarrhalis
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1. Gram – diplococci
2. 100% B-lactamase producing 3. Resistance can be overcome with a BLI |
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Treatment if <6 months old
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use Abx
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Treatment if 6 months to 2 years old
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use Abx if certain diagnosis OR severe illness
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Treatment if > 2 years old
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Use Abx if certain diagnosis AND severe illness
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observation option
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provide analgesia
wait 48-72 hours, consider antimicrobial |
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If T<39 and/or nonsevere otalgia, what is Tx
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amoxicillin 80-90 mg/kg/d
divided BID or TID |
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If T<39 and/or nonsevere otalgia, what is Tx if failure to respond in 48-72 hours
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90 mg/kg/d amox + 6.4 mg/kg/d clav
divided BID |
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If T>39 and/or severe otalgia, what is Tx
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90 mg/kg/d amox + 6.4 mg/kg/d clav
divided BID |
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If T>39 and/or severe otalgia, what is Tx, if failure at 48-72 hours after initial Abx
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ceftriaxone 50 mg/kg IM/IV qd x 3
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If PCN allergy (non-anaphylaxis), what is the alternative
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cephalosporins
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If PCN allergy (anaphylaxis), what is the alternative
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macrolides
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If persistant AOM, then...
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confirm diagnosis
clindamycin tympanocentesis and culture/sensitivity |
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recommended analgesics for pain ass'd with AOM
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a. **APAP 10-15 mg/kg q4-6h
b. Ibuprofen 5-10 mg/kg q6-8h c. If >1 year, benzocaine 20% otic solution 4-5 gtt q1-2h prn |
