Definition: Otitis media includes acute otitis media and otitis media with effusion.
Different types of OM.
Causative agents and treatment options.
Treatment
Causative agents and treatment options.
Acetaminophen, NSAIDs, and topic anesthetic ear drops, prn analgesia.
Immediate antibiotic use seems most beneficial in children younger than two years with bilateral AOM and in children who have AOM with ear discharge.”
“Myringotomy may be less effective than antibiotics at reducing symptoms, and we found no evidence that it is superior to no myringotomy.”
Pearls from AAP 2013 Guidelines
- “Amoxicillin may be more effective than macrolides and cephalosporin.”
- “Clinicians may offer tympanostomy tubes for recurrent AOM (3 episodes in 6 months or 4 episodes in 1 year with 1 episode in the preceding 6 months).” AAP 2013
- “Clinicians should prescribe an antibiotic with additional β-lactamase coverage for AOM when a decision to treat with antibiotics has been made, and the child has received amoxicillin in the last 30 days or has concurrent purulent conjunctivitis, or has a history of recurrent AOM unresponsive to amoxicillin. ” AAP 2013
- “The clinician should either prescribe antibiotic therapy or offer observation with close follow-up based on joint decision-making with the parent(s)/caregiver for AOM (bilateral or unilateral) in children 24 months or older without severe signs or symptoms (ie, mild otalgia for less than 48 hours and temperature less than 39°C [102.2°F]). When observation is used, a mechanism must be in place to ensure follow-up and begin antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of onset of symptoms.” http://pediatrics.aappublications.org/content/131/3/e964 ; read the rest of the guidelines there.
- Otitis Externa.
- Risk factors for AOM: “Group child care outside the home and passive smoking are thought to be the most important risk factors for AOM. Other risk factors include pacifier use and a family history of AOM. Breastfeeding for three months or longer has a protective effect.”
Reference
Pediatrics. March 2013, Volume 131 / Issue 3. http://pediatrics.aappublications.org/content/131/3/e964
https://emedicine.medscape.com/article/994656-overview
Am Fam Physician. 2017 Jan 15;95(2):109-110. http://www.aafp.org/afp/2017/0115/p109.html