Acute otitis media
Background
35-50% are caused by nontypable H inluenza
25-40% are caused Streptococcus pneumonae
5-10% Moraxella caterallis
5-15% viruses
Diagnosis
- acute onset <48 hours, chronic cases should be followed by PMD as may represent differnet diagnostic entity
- Middle Ear Effusion: bulging TM, otorrhea, anair/fluid level behind TM, or limited or absent TM mobility
- Middle Ear inflammation: erythema, of the TM or otalgia, but also need above symptoms
- Note: Please clean ear of cerumen with 1:1 solution peroxide and water and curette
Treatment
- Treat Pain! Acetaminophen and topical Benzocaine
- Narcotics not recommended because risk or respiratory depression ad altered mental status and generally not indicated unless SEVERE pain
- Some may be observed WITHOUT antibiotics (meta-analysis showed 7-20 children need to be treated with abx to see benefit)
- Infant <6months: treat with abx even if uncertain of diagnosis
- 6 months to 2 years: only if traid present or temp 39 or above and severe otalgia
- Well appearing kids may be treated symptomatically if do not meet triad (this assumes reliable caregiver and prompt Peds follow up
- if concern for perforated tympanic membrane, avoid using otic aminoglycoside solution (risk of ototoxicity). In this setting, suspension drops are safer to use.
Antibiotic Choices
Duration should be 10 days for children under 6yo
Duration should be 5-7 days for older children
- "high-dose" amoxicillin 80-90 mg/kg/day for most children
- If pcn allergy and not type 1 reaction may use cefdinir, cefuroxime, or cefpodoxime
- If pcn allergy anaphlaxis or uticaria use azithromyin, clarithromycin, ot trimethorpin-sulfamethoxazole
- ceftriaxone if cannot tolerate POs
Treatment Failures
- for fever and sxs > 72 hours after Tx begun (10%) - switch to Augmentin, Ceftriaxone IM x 3 d, Cefuroxime, Clinda.
See Also
ENT: Otitis Externa
Source
Recommendations 2004 by AAP/AAFP (apply to 2 month to 12 years)