Pediatric Infectious Otitis Media (L39)

recent antibiotic use (in the last _________) can increase the risk for antibiotic resistance

30 days

otalgia is ear _______

pain

tympanocentesis is pulling ________ out by sticking a needle through the __________

fluid, eardrum

_____________ is pulling fluid out by sticking a needle through the eardrum

tympanocentesis

symptoms of otitis media: pain (_________) and ________ indicative of acute otitis media

otalgia, fever

hearing impairment is indicative of ___________ ___________ (OME)

persistent effusion

_____________________ (s/sx) is indicative of persistent effusion (OME)

hearing impairment

discharge from the ear, called ___________, is indicative of perforation

otorrhea

_____________ from the ear, called otorrhea, is indicative of perforation

discharge

discharge from the ear, called otorrhea, is indicative of perforation

if the patient has tympanostomy tubes placed, drainage is common and is then indicative of chronic ____________ otitis media

suppurative

why do kids get ear infections? (much more likely under age of 2 y/o)

its because of the anatomy of the ___________ _______ and its angle

eustachian tube

why do kids get ear infections? (much more likely under age of 2 y/o)

its because of the anatomy of the eustachian tube and its ________

angle (more horizontal in kids; harder to drain shit out)

why do kids get ear infections? (much more likely under age of 2 y/o)

children with ______ ________ (abnormal) are also more susceptible due to anatomical disruptions

cleft palate

why do kids get ear infections? (much more likely under age of 2 y/o)

breastfeeding vs. bottle feeding

and if they are breastfed (yay!) it still depends on the _________ they are fed at

angle

What organism(s) cause acute otitis media? _________________ (most common and the one that is vaccinated against), ____________, and ____________

Streptococcus pneumoniae, M. catarrhalis, H. influenza

what is the most common cause of AOM

viruses

pain management for AOM is initiated within the first ________ if possible (Tylenol or Ibuprofen) (maybe warm compresses or laying down on side) (OTC eardrops, topical analgesics, etc. are NOT beneficial)

24 hours

_____________ is the first-line for healthy children aged 6 months to 2 y/o with non-severe illness and unilateral involvement and in healthy children >2 y/o with non-severe illness and without otorrhea

observation (+ pain management too!!)

OBSERVATION is the first-line for healthy children aged 6 months to 2 y/o with non-severe illness and unilateral involvement and in healthy children >2 y/o with non-severe illness and without otorrhea

in these patients we should defer antibiotic therapy for ___________ (how long)

48-72 hours (then at that point we can re-evaluate and prescribe abx if needed)

not all antibiotics reach adequate ________ ______ fluid concentrations

middle ear

not all antibiotics reach adequate middle ear fluid concentrations

ex: __________ is NOT an effective choice for AOM therapy

Erythromycin

not all antibiotics reach adequate middle ear fluid concentrations

ex: ___________ do treat AOM, but many are NOT effective against resistant organisms bcuz they don’t reach adequate middle ear concentrations

Cephalosporins

what is the dose of Amoxicillin as 1st-line treatment of non-severe AOM

80-90mg/ kg/ day (high dose!! cuz Strep develops resistance via Penicillin-Binding Protein shifts)

1st-line treatment of non-severe AOM is either Amoxicillin 80-90 mg/kg/day or ______________

observation

1st-line treatment of non-severe AOM is either Amoxicillin 80-90 mg/kg/day or observation

if started on Amoxicillin and but failed, we can switch to _____________ at the same dose

Augmentin (Amox/Clav)

1st-line treatment of non-severe AOM is either Amoxicillin 80-90 mg/kg/day or observation

if started on Amoxicillin and but failed, we can switch to Augmentin at __________ dose

the same (80-90 mg/kg/day)

1st-line treatment of non-severe AOM is either Amoxicillin 80-90 mg/kg/day or observation

if started on Augmentin and but failed, we can switch to _____________ or after that we could even do a ____________

Ceftriaxone, tympanocentesis

1st-line treatment of non-severe AOM is either Amoxicillin 80-90 mg/kg/day or observation

if the patient has an anaphylactic allergy to Amoxicillin, we can use ___________ instead

Cefuroxime

1st-line treatment of severe AOM is Amoxicillin 80-90 mg/kg/day or observation