-
For pts meeting dx criteria,1,2 otalgia tx if needed, plus: - If no amox in 30 days, no hx amox-unresponsive recurrence, no purulent conjunctivitis: amoxicillin 80-90 mg/kg/day PO bid x10 days [B/R]
- If amox in 30 days or hx amox-unresponsive recurrence or purulent conjunctivitis: amoxicillin/clavulanate 90/6.4 mg/kg/day PO bid x10 days [C/R]
If PCN allergy:3 - cefdinir 14 mg/kg/day PO daily/bid x10 days
- cefuroxime 30 mg/kg/day PO bid x10 days
- cefpodoxime 10 mg/kg/day PO bid x10 days
- ceftriaxone 50 mg/kg/day IM/IV x1-3 days
Otalgia tx if needed [B/R] - Mild-mod pain: acetaminophen or ibuprofen
- Mod-severe pain: codeine or analogs (consider ADR risk)
- Topicals: (only in pts >5 yo) benzocaine, procaine, lidocaine offer added brief benefit vs acetaminophen
- Naturopathic agents comparable to amethocaine/phenazone drops in pts >6 yo
Prophylactic abx not recommended [B/R] Prevention:4 pneumococcal conjugate vaccination [B/SR] & annual influenza vaccination [B/R] per AAP schedule, exclusive breastfeeding for 1st 6 mo of life [B/R], avoidance of tobacco smoke [C/R] Footnotes 1 Dx: mod-severe TM bulge OR new otorrhea (not otitis externa) [B/R] OR mild TM bulge w/ either intense TM erythema or <48 h onset ear pain [C/R]. Do not dx AOM in those w/o middle ear effusion based on pneumatic otoscopy and/or tympanometry [B/R].
2 Definition of severe sx: mod-severe otalgia or otalgia >48 h or fever ≥39°C.
3 Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
4 May offer T-tubes for recurrent AOM: either 3 episodes/6 mo or 4 episodes/1 yr, ≥1 episode in preceding 6 mo [B/O]. Xylitol 3-5x/day may be effective for prevention of recurrent AOM in children >2 yo. Home remedies/homeopathy: no controlled studies.
For pts meeting dx criteria,5,6 otalgia tx if needed, plus: - If no amox in 30 days, no hx amox-unresponsive recurrence, no purulent conjunctivitis: amoxicillin 80-90 mg/kg/day PO bid x10 days [B/R]
- If amox in 30 days or hx amox-unresponsive recurrence or purulent conjunctivitis: amoxicillin/clavulanate 90/6.4 mg/kg/day PO bid x10 days [C/R]
If PCN allergy:7 - cefdinir 14 mg/kg/day PO daily/bid x10 days
- cefuroxime 30 mg/kg/day PO bid x10 days
- cefpodoxime 10 mg/kg/day PO bid x10 days
- ceftriaxone 50 mg/kg/day IM/IV x1-3 days
Otalgia tx if needed [B/R] - Mild-mod pain: acetaminophen or ibuprofen
- Mod-severe pain: codeine or analogs (consider ADR risk)
Prophylactic abx not recommended [B/R] Prevention:8 pneumococcal conjugate vaccination [B/SR] & annual influenza vaccination [B/R] per AAP schedule, exclusive breastfeeding for 1st 6 mo of life [B/R], avoidance of tobacco smoke [C/R]. Footnotes 5 Dx: mod-severe TM bulge OR new otorrhea (not otitis externa) [B/R] OR mild TM bulge w/ either intense TM erythema or <48 h onset ear pain [C/R]. Do not dx AOM in those w/o middle ear effusion based on pneumatic otoscopy and/or tympanometry [B/R].
6 Definition of severe sx: mod-severe otalgia or otalgia >48 h or fever ≥39°C.
7 Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
8 May offer T-tubes for recurrent AOM: either 3 episodes/6 mo or 4 episodes/1 yr, ≥1 episode in preceding 6 mo [B/O]. Home remedies/homeopathy: no controlled studies.
For pts meeting dx criteria,9,10 otalgia tx if needed, plus either observe w/ close F/U or abx: - Observation: joint decision w/ caregiver; mechanism to ensure F/U + begin abx if worsens/fails to improve w/in 48-72 h of sx onset
- If no amox in 30 days, no hx amox-unresponsive recurrence, no purulent conjunctivitis: amoxicillin 80-90 mg/kg/day PO bid x10 days [B/R]
- If amox in 30 days or hx amox-unresponsive recurrence or purulent conjunctivitis: amoxicillin/clavulanate 90/6.4 mg/kg/day PO bid x10 days [C/R]
If PCN allergy:11 - cefdinir 14 mg/kg/day PO daily/bid x10 days
- cefuroxime 30 mg/kg/day PO bid x10 days
- cefpodoxime 10 mg/kg/day PO bid x10 days
- ceftriaxone 50 mg/kg/day IM/IV x1-3 days
Otalgia tx if needed [B/R] - Mild-mod pain: acetaminophen or ibuprofen
- Mod-severe pain: codeine or analogs (consider side-effect risk)
Prophylactic abx not recommended [B/R] Prevention:12 pneumococcal conjugate vaccination [B/SR] & annual influenza vaccination [B/R] per AAP schedule, exclusive breastfeeding for 1st 6 mo of life [B/R], avoidance of tobacco smoke [C/R]. Footnotes 9 Dx: mod-severe TM bulge OR new otorrhea (not otitis externa) [B/R] OR mild TM bulge w/ either intense TM erythema or <48 h onset ear pain [C/R]. Do not dx AOM in those w/o middle ear effusion based on pneumatic otoscopy and/or tympanometry [B/R].
10 Definition of severe sx: mod-severe otalgia or otalgia >48 h or fever ≥39°C.
11 Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
12 May offer T-tubes for recurrent AOM: either 3 episodes/6 mo or 4 episodes/1 yr, ≥1 episode in preceding 6 mo [B/O]. Home remedies/homeopathy: no controlled studies.
For pts meeting dx criteria,13,14 otalgia tx if needed, plus either observe w/ close F/U or abx: - Observation: joint decision w/ caregiver; mechanism to ensure F/U + begin abx if worsens/fails to improve w/in 48-72 h of sx onset
- If no amox in 30 days, no hx amox-unresponsive recurrence, no purulent conjunctivitis: amoxicillin 80-90 mg/kg/day PO bid15 [B/R]
- If amox in 30 days or hx amox-unresponsive recurrence or purulent conjunctivitis: amoxicillin/clavulanate 90/6.4 mg/kg/day PO bid15 [C/R]
If PCN allergy:16 - cefdinir 14 mg/kg/day PO daily/bid15
- cefuroxime 30 mg/kg/day PO bid15
- cefpodoxime 10 mg/kg/day PO bid15
- ceftriaxone 50 mg/kg/day IM/IV x1-3 days
Otalgia tx if needed [B/R] - Mild-mod pain: acetaminophen or ibuprofen
- Mod-severe pain: codeine or analogs (consider side-effect risk)
- Only in pts >5 yo, benzocaine, procaine, lidocaine offer added brief benefit vs acetaminophen
- Naturopathic agents comparable to amethocaine/phenazone drops in pts >6 yo
Prophylactic abx not recommended [B/R] Prevention:17 pneumococcal conjugate vaccination [B/SR] & annual influenza vaccination [B/R] per AAP schedule, exclusive breastfeeding for 1st 6 mo of life [B/R], avoidance of tobacco smoke [C/R] Footnotes 13 Dx: mod-severe TM bulge OR new otorrhea (not otitis externa) [B/R] OR mild TM bulge w/ either intense TM erythema or <48 h onset ear pain [C/R]. Do not dx AOM in those w/o middle ear effusion based on pneumatic otoscopy and/or tympanometry [B/R].
14 Definition of severe sx: mod-severe otalgia or otalgia >48 h or fever ≥39°C
15 Abx duration: 2-5 yo: 7 days; ≥6 yo: 5-7 days.
16 Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
17 May offer T-tubes for recurrent AOM: either 3 episodes/6 mo or 4 episodes/1 yr, ≥1 episode in preceding 6 mo [B/O]. Xylitol 3-5x/day may be effective for prevention of recurrent AOM in children >2 yo. Home remedies/homeopathy: no controlled studies.
-
Worsening/failing to respond w/in 48-72h of tx
For AOM pts worsening or failing to respond at 48-72h after tx:18,19 - amoxicillin/clavulanate 90/6.4 mg/kg/day PO bid20
- ceftriaxone 50 mg/kg/day IM/IV x3 days21
- clindamycin 30-40 mg/kg/day PO tid20
- clindamycin 30-40 mg/kg/day PO tid + cefdinir 14 mg/kg/day PO daily or bid20
- clindamycin 30-40 mg/kg/day PO tid + cefuroxime 30 mg/kg/day PO bid20
- clindamycin 30-40 mg/kg/day PO tid + cefpodoxime 10 mg/kg/day PO bid20
Otalgia tx if needed [B/R] - Mild-mod pain: acetaminophen or ibuprofen
- Mod-severe pain: codeine or analogs (consider ADR risk)
- Only in pts >5 yo, benzocaine, procaine, lidocaine offer added brief benefit vs acetaminophen
- Naturopathic agents comparable to amethocaine/phenazone drops in pts >6 yo
Prophylactic abx not recommended [B/R] Prevention:22 pneumococcal conjugate vaccination [B/SR] & annual influenza vaccination [B/R] per AAP schedule, exclusive breastfeeding for 1st 6 mo of life [B/R], avoidance of tobacco smoke [C/R] Footnotes 18 Consult specialist, consider tympanocentesis if series of abx fail, consider linezolid or levofloxacin.
19 Dx: mod-severe TM bulge OR new otorrhea (not otitis externa) [B/R] OR mild TM bulge w/ either intense TM erythema or <48 h onset ear pain [C/R]. Do not dx AOM in those w/o middle ear effusion based on pneumatic otoscopy and/or tympanometry [B/R].
20 Abx duration: <2 yo, or severe sx: 10 days; 2-5 yo mild-mod AOM: 7 days; ≥6 yo mild-mod: 5-7 days.
21 Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
22 May offer T-tubes for recurrent AOM: either 3 episodes/6 mo or 4 episodes/1 yr, ≥1 episode in preceding 6 mo [B/O]. Xylitol 3-5x/day may be effective for prevention of recurrent AOM in children >2 yo. Home remedies/homeopathy: no controlled studies.
|
