Otitis media medical therapy: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(3 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Otitis media}}
{{Otitis media}}
{{CMG}}
{{CMG}} {{AE}} {{Maliha}}; {{SC}}; {{MM}}; {{LRO}}


==Overview==
==Overview==
The mainstay of therapy for acute otitis media (AOM) is antimicrobial therapy. High-dose [[Amoxicillin]] is the drug of choice for initial antibiotic therapy; high-dose [[Amoxicillin-Clavulanate]] or [[intramuscular]] [[Ceftriaxone]] should be reserved for patients who fail to respond to first-line treatment within 48 to 72 hours. Antimicrobial agents covering common bacterial pathogens (e.g., ''[[Streptococcus pneumoniae]]'', ''[[Moraxella catarrhalis]]'', and non-typeable ''[[Haemophilus influenzae]]'') have been used with success in selected patients to accelerate the recovery and lower the risk of [[tympanic membrane perforation]]s and contralateral AOM episodes.<ref>{{Cite journal| doi = 10.1002/14651858.CD000219.pub3| issn = 1469-493X| volume = 1| pages = –000219| last1 = Venekamp| first1 = Roderick P.| last2 = Sanders| first2 = Sharon| last3 = Glasziou| first3 = Paul P.| last4 = Del Mar| first4 = Chris B.| last5 = Rovers| first5 = Maroeska M.| title = Antibiotics for acute otitis media in children| journal = The Cochrane Database of Systematic Reviews| date = 2013| pmid = 23440776}}</ref> . The optimal duration of antibiotics remains uncertain: a 10-day course of antibiotic therapy is recommended for children younger than 2 years and children with severe symptoms. In the absence of severe symptoms, a 7- or 5-day course is advisable for children 2 to 5 years of age or children 6 years and older, respectively. Current guidelines recommend observation for children age 6 to 24 months with unilateral AOM without [[otorrhea]] or children older than 2 years with unilateral or bilateral AOM without [[otorrhea]].<ref>{{Cite journal| doi = 10.1136/archdischild-2013-305550| issn = 1743-0593| last1 = Siddiq| first1 = Somiah| last2 = Grainger| first2 = Joe| last3 = Prentice| first3 = Philippa| title = The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013| journal = Archives of Disease in Childhood. Education and Practice Edition| date = 2014-11-12| pmid = 25395494}}</ref> [[Otalgia]] is generally managed with [[Acetaminophen]], [[Ibuprofen]], or [[narcotic]] [[analgesic]]s with [[Codeine]].<ref>{{Cite journal| doi = 10.1136/archdischild-2013-305550| issn = 1743-0593| last1 = Siddiq| first1 = Somiah| last2 = Grainger| first2 = Joe| last3 = Prentice| first3 = Philippa| title = The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013| journal = Archives of Disease in Childhood. Education and Practice Edition| date = 2014-11-12| pmid = 25395494}}</ref>
The mainstay of therapy for acute otitis media (AOM) is antimicrobial therapy. High-dose [[Amoxicillin]] is the drug of choice for initial antibiotic therapy; high-dose [[Amoxicillin-Clavulanate]] or [[intramuscular]] [[Ceftriaxone]] should be reserved for patients who fail to respond to first-line treatment within 48 to 72 hours. Antimicrobial agents covering common bacterial pathogens (e.g., ''[[Streptococcus pneumoniae]]'', ''[[Moraxella catarrhalis]]'', and non-typeable ''[[Haemophilus influenzae]]'') have been used with success in selected patients to accelerate the recovery and lower the risk of [[tympanic membrane perforation]]s and contralateral AOM episodes.<ref>{{Cite journal| doi = 10.1002/14651858.CD000219.pub3| issn = 1469-493X| volume = 1| pages = –000219| last1 = Venekamp| first1 = Roderick P.| last2 = Sanders| first2 = Sharon| last3 = Glasziou| first3 = Paul P.| last4 = Del Mar| first4 = Chris B.| last5 = Rovers| first5 = Maroeska M.| title = Antibiotics for acute otitis media in children| journal = The Cochrane Database of Systematic Reviews| date = 2013| pmid = 23440776}}</ref> The optimal duration of antibiotics remains uncertain: a 10-day course of antibiotic therapy is recommended for children younger than 2 years and children with severe symptoms. In the absence of severe symptoms, a 7- or 5-day course is advisable for children 2 to 5 years of age or children 6 years and older, respectively. Current guidelines recommend observation for children age 6 to 24 months with unilateral AOM without [[otorrhea]] or children older than 2 years with unilateral or bilateral AOM without [[otorrhea]].<ref>{{Cite journal| doi = 10.1136/archdischild-2013-305550| issn = 1743-0593| last1 = Siddiq| first1 = Somiah| last2 = Grainger| first2 = Joe| last3 = Prentice| first3 = Philippa| title = The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013| journal = Archives of Disease in Childhood. Education and Practice Edition| date = 2014-11-12| pmid = 25395494}}</ref> [[Otalgia]] is generally managed with [[Acetaminophen]], [[Ibuprofen]], or [[narcotic]] [[analgesic]]s with [[Codeine]].<ref>{{Cite journal| doi = 10.1136/archdischild-2013-305550| issn = 1743-0593| last1 = Siddiq| first1 = Somiah| last2 = Grainger| first2 = Joe| last3 = Prentice| first3 = Philippa| title = The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013| journal = Archives of Disease in Childhood. Education and Practice Edition| date = 2014-11-12| pmid = 25395494}}</ref>
 
==Medical Therapy==
===Initial Management of Uncomplicated Acute Otitis Media with High Certainty of Diagnosis===


==Initial Management of Uncomplicated AOM with High Certainty of Diagnosis==
{| style="font-size: 85%;"
{| style="font-size: 85%;"
|+ '''Clinical Practice Guideline from the American Academy of Pediatrics'''<ref>{{Cite journal| doi = 10.1136/archdischild-2013-305550| issn = 1743-0593| last1 = Siddiq| first1 = Somiah| last2 = Grainger| first2 = Joe| last3 = Prentice| first3 = Philippa| title = The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013| journal = Archives of Disease in Childhood. Education and Practice Edition| date = 2014-11-12| pmid = 25395494}}</ref>
|+ '''Clinical Practice Guideline from the American Academy of Pediatrics'''<ref>{{Cite journal| doi = 10.1136/archdischild-2013-305550| issn = 1743-0593| last1 = Siddiq| first1 = Somiah| last2 = Grainger| first2 = Joe| last3 = Prentice| first3 = Philippa| title = The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013| journal = Archives of Disease in Childhood. Education and Practice Edition| date = 2014-11-12| pmid = 25395494}}</ref>
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | Age
| style="padding: 2px 10px; background: #4479BA; color: #FFFFFF;" | Age
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | AOM With Otorrhea
| style="padding: 2px 10px; background: #4479BA; color: #FFFFFF;" | AOM With Otorrhea
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | AOM With Severe Symptoms<sup>†</sup>
| style="padding: 2px 10px; background: #4479BA; color: #FFFFFF;" | AOM With Severe Symptoms<sup>†</sup>
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | Bilateral AOM Without Otorrhea
| style="padding: 2px 10px; background: #4479BA; color: #FFFFFF;" | Bilateral AOM Without Otorrhea
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | Unilateral AOM Without Otorrhea
| style="padding: 2px 10px; background: #4479BA; color: #FFFFFF;" | Unilateral AOM Without Otorrhea
|-
|-
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | 6 mo to 2 y
| style="padding: 2px 10px; background: #DCDCDC;" | 6 months to 2 years old
| style="padding: 2px 10px; background: #A8A8A8;" | Antibiotic therapy
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy
| style="padding: 2px 10px; background: #A8A8A8;" | Antibiotic therapy  
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy  
| style="padding: 2px 10px; background: #A8A8A8;" | Antibiotic therapy
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy
| style="padding: 2px 10px; background: #DCDCDC;" | Antibiotic therapy or additional observation  
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy or additional observation  
|-
|-
| style="padding: 2px 10px; background: #545454; color: #F8F8FF;" | ≥ 2 y
| style="padding: 2px 10px; background: #DCDCDC;" | ≥ 2 years old
| style="padding: 2px 10px; background: #A8A8A8;" | Antibiotic therapy
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy
| style="padding: 2px 10px; background: #A8A8A8;" | Antibiotic therapy  
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy  
| style="padding: 2px 10px; background: #DCDCDC;" | Antibiotic therapy or additional observation  
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy or additional observation  
| style="padding: 2px 10px; background: #DCDCDC;" | Antibiotic therapy or additional observation  
| style="padding: 2px 10px; background: #F5F5F5;" | Antibiotic therapy or additional observation  
|}
|}
<SMALL><sup>†</sup> A toxic-appearing child, persistent otalgia more than 48 h, temperature ≥39°C (102.2°F) in the past 48 h, or if there is uncertain access to follow-up after the visit.</SMALL>
<SMALL><sup>†</sup> A toxic-appearing child, persistent otalgia more than 48 h, temperature ≥39°C (102.2°F) in the past 48 h, or if there is uncertain access to follow-up after the visit.</SMALL>


==Observation==
===Rationale for Antibiotic Therapy Choice===
Due to the self-limited nature of most episodes of AOM (particularly in children 2 years and older), initial observation is advisable for selected patients if close follow-up can be ensured and rescue antibiotics administered for persistent or worsening symptoms in 48 to 72 hours.
 
==Antibiotic Therapy==
 
===Rationale for Antibiotic Choice===
The rationale for antibiotic therapy in children with AOM is based on a high prevalence of bacteria from [[tympanocentesis]] cultures.  A significant benefit of immediate antibiotic therapy is most evident in bilateral AOM, AOM with severe symptotms, AOM with [[otorrhea]], or ''[[Streptococcus pneumoniae]]'' infection.<ref>{{Cite journal| doi = 10.1016/S0140-6736(06)69606-2| issn = 1474-547X| volume = 368| issue = 9545| pages = 1429–1435| last1 = Rovers| first1 = Maroeska M.| last2 = Glasziou| first2 = Paul| last3 = Appelman| first3 = Cees L.| last4 = Burke| first4 = Peter| last5 = McCormick| first5 = David P.| last6 = Damoiseaux| first6 = Roger A.| last7 = Gaboury| first7 = Isabelle| last8 = Little| first8 = Paul| last9 = Hoes| first9 = Arno W.| title = Antibiotics for acute otitis media: a meta-analysis with individual patient data| journal = Lancet| date = 2006-10-21| pmid = 17055944}}</ref>  Antibiotic therapy is recommended in the following settings:
The rationale for antibiotic therapy in children with AOM is based on a high prevalence of bacteria from [[tympanocentesis]] cultures.  A significant benefit of immediate antibiotic therapy is most evident in bilateral AOM, AOM with severe symptotms, AOM with [[otorrhea]], or ''[[Streptococcus pneumoniae]]'' infection.<ref>{{Cite journal| doi = 10.1016/S0140-6736(06)69606-2| issn = 1474-547X| volume = 368| issue = 9545| pages = 1429–1435| last1 = Rovers| first1 = Maroeska M.| last2 = Glasziou| first2 = Paul| last3 = Appelman| first3 = Cees L.| last4 = Burke| first4 = Peter| last5 = McCormick| first5 = David P.| last6 = Damoiseaux| first6 = Roger A.| last7 = Gaboury| first7 = Isabelle| last8 = Little| first8 = Paul| last9 = Hoes| first9 = Arno W.| title = Antibiotics for acute otitis media: a meta-analysis with individual patient data| journal = Lancet| date = 2006-10-21| pmid = 17055944}}</ref>  Antibiotic therapy is recommended in the following settings:
* AOM (bilateral or unilateral) in children 6 months and older with '''severe signs or symptoms''' (i.e., moderate or severe otalgia or otalgia for at least 48 hours, or temperature 39°C [102.2°F] or higher)
* AOM (bilateral or unilateral) in children 6 months and older with '''severe signs or symptoms''' (i.e., moderate or severe otalgia or otalgia for at least 48 hours, or temperature 39°C [102.2°F] or higher)
Line 40: Line 37:


When a decision to treat with antibiotics has been made, high-dose [[amoxicillin]] is recommended if all of the following criteria are fulfilled:<ref>{{Cite journal| doi = 10.1542/peds.2012-3488| issn = 1098-4275| volume = 131| issue = 3| pages = –964-999| last1 = Lieberthal| first1 = Allan S.| last2 = Carroll| first2 = Aaron E.| last3 = Chonmaitree| first3 = Tasnee| last4 = Ganiats| first4 = Theodore G.| last5 = Hoberman| first5 = Alejandro| last6 = Jackson| first6 = Mary Anne| last7 = Joffe| first7 = Mark D.| last8 = Miller| first8 = Donald T.| last9 = Rosenfeld| first9 = Richard M.| last10 = Sevilla| first10 = Xavier D.| last11 = Schwartz| first11 = Richard H.| last12 = Thomas| first12 = Pauline A.| last13 = Tunkel| first13 = David E.| title = The diagnosis and management of acute otitis media| journal = Pediatrics| date = 2013-03| pmid = 23439909}}</ref>
When a decision to treat with antibiotics has been made, high-dose [[amoxicillin]] is recommended if all of the following criteria are fulfilled:<ref>{{Cite journal| doi = 10.1542/peds.2012-3488| issn = 1098-4275| volume = 131| issue = 3| pages = –964-999| last1 = Lieberthal| first1 = Allan S.| last2 = Carroll| first2 = Aaron E.| last3 = Chonmaitree| first3 = Tasnee| last4 = Ganiats| first4 = Theodore G.| last5 = Hoberman| first5 = Alejandro| last6 = Jackson| first6 = Mary Anne| last7 = Joffe| first7 = Mark D.| last8 = Miller| first8 = Donald T.| last9 = Rosenfeld| first9 = Richard M.| last10 = Sevilla| first10 = Xavier D.| last11 = Schwartz| first11 = Richard H.| last12 = Thomas| first12 = Pauline A.| last13 = Tunkel| first13 = David E.| title = The diagnosis and management of acute otitis media| journal = Pediatrics| date = 2013-03| pmid = 23439909}}</ref>
* The patient has not received [[amoxicillin]] in the past 30 days.
*The patient has not received [[amoxicillin]] in the past 30 days.
* The patient does not have concurrent purulent [[conjunctivitis]].
*The patient does not have concurrent purulent [[conjunctivitis]].
* The patient is not allergic to [[penicillin]].
*The patient is not allergic to [[penicillin]].


Additional [[Beta-lactamase|β-lactamase]] coverage should be considered if any of the following criteria is fulfilled:<ref>{{Cite journal| doi = 10.1542/peds.2012-3488| issn = 1098-4275| volume = 131| issue = 3| pages = –964-999| last1 = Lieberthal| first1 = Allan S.| last2 = Carroll| first2 = Aaron E.| last3 = Chonmaitree| first3 = Tasnee| last4 = Ganiats| first4 = Theodore G.| last5 = Hoberman| first5 = Alejandro| last6 = Jackson| first6 = Mary Anne| last7 = Joffe| first7 = Mark D.| last8 = Miller| first8 = Donald T.| last9 = Rosenfeld| first9 = Richard M.| last10 = Sevilla| first10 = Xavier D.| last11 = Schwartz| first11 = Richard H.| last12 = Thomas| first12 = Pauline A.| last13 = Tunkel| first13 = David E.| title = The diagnosis and management of acute otitis media| journal = Pediatrics| date = 2013-03| pmid = 23439909}}</ref>
Additional [[Beta-lactamase|β-lactamase]] coverage should be considered if any of the following criteria is fulfilled:<ref>{{Cite journal| doi = 10.1542/peds.2012-3488| issn = 1098-4275| volume = 131| issue = 3| pages = –964-999| last1 = Lieberthal| first1 = Allan S.| last2 = Carroll| first2 = Aaron E.| last3 = Chonmaitree| first3 = Tasnee| last4 = Ganiats| first4 = Theodore G.| last5 = Hoberman| first5 = Alejandro| last6 = Jackson| first6 = Mary Anne| last7 = Joffe| first7 = Mark D.| last8 = Miller| first8 = Donald T.| last9 = Rosenfeld| first9 = Richard M.| last10 = Sevilla| first10 = Xavier D.| last11 = Schwartz| first11 = Richard H.| last12 = Thomas| first12 = Pauline A.| last13 = Tunkel| first13 = David E.| title = The diagnosis and management of acute otitis media| journal = Pediatrics| date = 2013-03| pmid = 23439909}}</ref>
* The patient has received [[amoxicillin]] in the past 30 days.
*The patient has received [[amoxicillin]] in the past 30 days.
* The patient has concurrent [[purulent]] [[conjunctivitis]].
*The patient has concurrent [[purulent]] [[conjunctivitis]].
* The patient has a history of recurrent AOM unresponsive to [[amoxicillin]].
*The patient has a history of recurrent AOM unresponsive to [[amoxicillin]].


===Duration of Therapy===
===Duration of Therapy===
The optimal duration of antibiotics remains unsettled.  Standard 10-day course of antibiotic therapy is recommended for children younger than 2 years and children with severe symptoms.  In the absence of severe symptoms, a 7- or 5-day course is advisable for children 2 to 5 years of age or children 6 years and older, respectively.
*Standard 10-day course of antibiotic therapy is recommended for children younger than 2 years and children with severe symptoms.   
*In the absence of severe symptoms, a 7- or 5-day course is advisable for children 2 to 5 years of age or children 6 years and older, respectively.


===Antibiotic Regimens===
===Antibiotic Regimens===
====Initial (Immediate or Delayed) Antibiotic Treatment====
====Initial (Immediate or Delayed) Antibiotic Treatment====
{{rx|Preferred Regimen}}
*Preferred Regimen
* [[Amoxicillin]] 80–90 mg/kg/d bid {{or}} [[Amoxicillin]] 90 mg/kg/d with [[Clavulanate]] 6.4 mg/kg/d
**[[Amoxicillin]] 80–90 mg/kg/d bid {{or}} [[Amoxicillin]] 90 mg/kg/d with [[Clavulanate]] 6.4 mg/kg/d
</li>
*Alternative Regimen (if allergic to [[penicillin]])
{{rx|Alternative Regimen (if allergic to penicillin)}}
**[[Cefdinir]] 14 mg/kg/d qd or bid {{or}} [[Cefuroxime]] 30 mg/kg/d bid {{or}} [[Cefpodoxime]] 10 mg/kg/d bid {{or}} [[Ceftriaxone]] 50 mg/kg IM/IV qd
* [[Cefdinir]] 14 mg/kg/d qd or bid {{or}} [[Cefuroxime]] 30 mg/kg/d bid {{or}} [[Cefpodoxime]] 10 mg/kg/d bid {{or}} [[Ceftriaxone]] 50 mg/kg IM/IV qd
</li>


====After Failure of Initial Antibiotic Treatment====
====After Failure of Initial Antibiotic Treatment====
{{rx|Preferred Regimen}}
*Preferred Regimen
* [[Amoxicillin]] 90 mg/kg/d with [[Clavulanate]] 6.4 mg/kg/d {{or}} [[Ceftriaxone]] 50 mg/kg IM/IV qd
**[[Amoxicillin]] 90 mg/kg/d with [[Clavulanate]] 6.4 mg/kg/d {{or}} [[Ceftriaxone]] 50 mg/kg IM/IV qd
</li>
*Alternative Regimen
{{rx|Alternative Regimen}}
**[[Clindamycin]] 30–40 mg/kg/d tid ± 3° [[Cephalosporin]] ± [[Tympanocentesis]]
* [[Clindamycin]] 30–40 mg/kg/d tid ± 3° [[Cephalosporin]] ± [[Tympanocentesis]]
</li>


==Pain Management==
===Pain Management===
Episodes of AOM are commonly associated with [[otalgia]]. [[Acetaminophen]] and [[ibuprofen]] are the mainstay of management for mild to moderate [[ear pain]].  [[Narcotic]] [[analgesia]] with [[codeine]] should be used with caution in the treatment of severe [[otalgia]] due to the risk of [[respiratory depression]], [[altered mental status]], [[abdominal pain|gastrointestinal upset]], and [[constipation]].<ref>{{Cite journal| doi = 10.1542/peds.2012-3488| issn = 1098-4275| volume = 131| issue = 3| pages = –964-999| last1 = Lieberthal| first1 = Allan S.| last2 = Carroll| first2 = Aaron E.| last3 = Chonmaitree| first3 = Tasnee| last4 = Ganiats| first4 = Theodore G.| last5 = Hoberman| first5 = Alejandro| last6 = Jackson| first6 = Mary Anne| last7 = Joffe| first7 = Mark D.| last8 = Miller| first8 = Donald T.| last9 = Rosenfeld| first9 = Richard M.| last10 = Sevilla| first10 = Xavier D.| last11 = Schwartz| first11 = Richard H.| last12 = Thomas| first12 = Pauline A.| last13 = Tunkel| first13 = David E.| title = The diagnosis and management of acute otitis media| journal = Pediatrics| date = 2013-03| pmid = 23439909}}</ref>
Episodes of AOM are commonly associated with [[otalgia]], managed by the following:  
*[[Acetaminophen]]  
*[[Ibuprofen]]  
*[[Codeine]]  
**Should be used with caution in the treatment of severe [[otalgia]] due to the risk of [[respiratory depression]], [[altered mental status]], [[abdominal pain|gastrointestinal upset]], and [[constipation]]. <ref>{{Cite journal| doi = 10.1542/peds.2012-3488| issn = 1098-4275| volume = 131| issue = 3| pages = –964-999| last1 = Lieberthal| first1 = Allan S.| last2 = Carroll| first2 = Aaron E.| last3 = Chonmaitree| first3 = Tasnee| last4 = Ganiats| first4 = Theodore G.| last5 = Hoberman| first5 = Alejandro| last6 = Jackson| first6 = Mary Anne| last7 = Joffe| first7 = Mark D.| last8 = Miller| first8 = Donald T.| last9 = Rosenfeld| first9 = Richard M.| last10 = Sevilla| first10 = Xavier D.| last11 = Schwartz| first11 = Richard H.| last12 = Thomas| first12 = Pauline A.| last13 = Tunkel| first13 = David E.| title = The diagnosis and management of acute otitis media| journal = Pediatrics| date = 2013-03| pmid = 23439909}}</ref>


==Antimicrobial regimen==
===Antimicrobial regimens===
*'''Acute otitis media''' <ref name="pmid23439909">{{cite journal| author=Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al.| title=The diagnosis and management of acute otitis media. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 3 | pages= e964-99 | pmid=23439909 | doi=10.1542/peds.2012-3488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439909  }} </ref>
*'''Acute otitis media''' <ref name="pmid23439909">{{cite journal| author=Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al.| title=The diagnosis and management of acute otitis media. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 3 | pages= e964-99 | pmid=23439909 | doi=10.1542/peds.2012-3488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439909  }} </ref>
:*'''1. Causative pathogens'''
:*'''1. Causative pathogens'''
Line 96: Line 93:


[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Inflammations]]
[[Category:Inflammations]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Otology]]
[[Category:Otology]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]
[[Category:Infectious Disease Project]]
[[Category:Infectious Disease Project]]

Latest revision as of 23:30, 29 July 2020

Otitis media Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Classification

Differentiating Otitis Media from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT or MRI

Other Imaging Findings

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Case Studies

Case #1

Otitis media medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Otitis media medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onOtitis media medical therapy

CDC on Otitis media medical therapy

media medical therapy in the news

on Otitis media medical therapy

Directions to Hospitals Treating Otitis media

Risk calculators and risk factors for Otitis media medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]; Shanshan Cen, M.D. [3]; Mohamed Moubarak, M.D. [4]; Luke Rusowicz-Orazem, B.S.

Overview

The mainstay of therapy for acute otitis media (AOM) is antimicrobial therapy. High-dose Amoxicillin is the drug of choice for initial antibiotic therapy; high-dose Amoxicillin-Clavulanate or intramuscular Ceftriaxone should be reserved for patients who fail to respond to first-line treatment within 48 to 72 hours. Antimicrobial agents covering common bacterial pathogens (e.g., Streptococcus pneumoniae, Moraxella catarrhalis, and non-typeable Haemophilus influenzae) have been used with success in selected patients to accelerate the recovery and lower the risk of tympanic membrane perforations and contralateral AOM episodes.[1] The optimal duration of antibiotics remains uncertain: a 10-day course of antibiotic therapy is recommended for children younger than 2 years and children with severe symptoms. In the absence of severe symptoms, a 7- or 5-day course is advisable for children 2 to 5 years of age or children 6 years and older, respectively. Current guidelines recommend observation for children age 6 to 24 months with unilateral AOM without otorrhea or children older than 2 years with unilateral or bilateral AOM without otorrhea.[2] Otalgia is generally managed with Acetaminophen, Ibuprofen, or narcotic analgesics with Codeine.[3]

Medical Therapy

Initial Management of Uncomplicated Acute Otitis Media with High Certainty of Diagnosis

Clinical Practice Guideline from the American Academy of Pediatrics[4]
Age AOM With Otorrhea AOM With Severe Symptoms Bilateral AOM Without Otorrhea Unilateral AOM Without Otorrhea
6 months to 2 years old Antibiotic therapy Antibiotic therapy Antibiotic therapy Antibiotic therapy or additional observation
≥ 2 years old Antibiotic therapy Antibiotic therapy Antibiotic therapy or additional observation Antibiotic therapy or additional observation

A toxic-appearing child, persistent otalgia more than 48 h, temperature ≥39°C (102.2°F) in the past 48 h, or if there is uncertain access to follow-up after the visit.

Rationale for Antibiotic Therapy Choice

The rationale for antibiotic therapy in children with AOM is based on a high prevalence of bacteria from tympanocentesis cultures. A significant benefit of immediate antibiotic therapy is most evident in bilateral AOM, AOM with severe symptotms, AOM with otorrhea, or Streptococcus pneumoniae infection.[5] Antibiotic therapy is recommended in the following settings:

  • AOM (bilateral or unilateral) in children 6 months and older with severe signs or symptoms (i.e., moderate or severe otalgia or otalgia for at least 48 hours, or temperature 39°C [102.2°F] or higher)
  • Bilateral AOM in children younger than 24 months without severe signs or symptoms

When a decision to treat with antibiotics has been made, high-dose amoxicillin is recommended if all of the following criteria are fulfilled:[6]

Additional β-lactamase coverage should be considered if any of the following criteria is fulfilled:[7]

Duration of Therapy

  • Standard 10-day course of antibiotic therapy is recommended for children younger than 2 years and children with severe symptoms.
  • In the absence of severe symptoms, a 7- or 5-day course is advisable for children 2 to 5 years of age or children 6 years and older, respectively.

Antibiotic Regimens

Initial (Immediate or Delayed) Antibiotic Treatment

After Failure of Initial Antibiotic Treatment

Pain Management

Episodes of AOM are commonly associated with otalgia, managed by the following:

Antimicrobial regimens

  • Acute otitis media [9]
  • 1. Causative pathogens
  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Moraxella catarrhalis
  • Polymicrobial
  • Viral
  • 2. Empiric antimicrobial therapy
  • 3. Special considerations
  • 3.1 Acute otitis media post-treatment failure (48-72 hours)
  • 3.2 Acute otitis media post-intubation[10]

References

  1. Venekamp, Roderick P.; Sanders, Sharon; Glasziou, Paul P.; Del Mar, Chris B.; Rovers, Maroeska M. (2013). "Antibiotics for acute otitis media in children". The Cochrane Database of Systematic Reviews. 1: –000219. doi:10.1002/14651858.CD000219.pub3. ISSN 1469-493X. PMID 23440776.
  2. Siddiq, Somiah; Grainger, Joe; Prentice, Philippa (2014-11-12). "The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013". Archives of Disease in Childhood. Education and Practice Edition. doi:10.1136/archdischild-2013-305550. ISSN 1743-0593. PMID 25395494.
  3. Siddiq, Somiah; Grainger, Joe; Prentice, Philippa (2014-11-12). "The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013". Archives of Disease in Childhood. Education and Practice Edition. doi:10.1136/archdischild-2013-305550. ISSN 1743-0593. PMID 25395494.
  4. Siddiq, Somiah; Grainger, Joe; Prentice, Philippa (2014-11-12). "The diagnosis and management of acute otitis media: American Academy of Pediatrics Guidelines 2013". Archives of Disease in Childhood. Education and Practice Edition. doi:10.1136/archdischild-2013-305550. ISSN 1743-0593. PMID 25395494.
  5. Rovers, Maroeska M.; Glasziou, Paul; Appelman, Cees L.; Burke, Peter; McCormick, David P.; Damoiseaux, Roger A.; Gaboury, Isabelle; Little, Paul; Hoes, Arno W. (2006-10-21). "Antibiotics for acute otitis media: a meta-analysis with individual patient data". Lancet. 368 (9545): 1429–1435. doi:10.1016/S0140-6736(06)69606-2. ISSN 1474-547X. PMID 17055944.
  6. Lieberthal, Allan S.; Carroll, Aaron E.; Chonmaitree, Tasnee; Ganiats, Theodore G.; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D.; Miller, Donald T.; Rosenfeld, Richard M.; Sevilla, Xavier D.; Schwartz, Richard H.; Thomas, Pauline A.; Tunkel, David E. (2013-03). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): –964-999. doi:10.1542/peds.2012-3488. ISSN 1098-4275. PMID 23439909. Check date values in: |date= (help)
  7. Lieberthal, Allan S.; Carroll, Aaron E.; Chonmaitree, Tasnee; Ganiats, Theodore G.; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D.; Miller, Donald T.; Rosenfeld, Richard M.; Sevilla, Xavier D.; Schwartz, Richard H.; Thomas, Pauline A.; Tunkel, David E. (2013-03). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): –964-999. doi:10.1542/peds.2012-3488. ISSN 1098-4275. PMID 23439909. Check date values in: |date= (help)
  8. Lieberthal, Allan S.; Carroll, Aaron E.; Chonmaitree, Tasnee; Ganiats, Theodore G.; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D.; Miller, Donald T.; Rosenfeld, Richard M.; Sevilla, Xavier D.; Schwartz, Richard H.; Thomas, Pauline A.; Tunkel, David E. (2013-03). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): –964-999. doi:10.1542/peds.2012-3488. ISSN 1098-4275. PMID 23439909. Check date values in: |date= (help)
  9. Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA; et al. (2013). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
  10. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.