Acute Otitis Media

Condition

• Acute Otitis Media 

Definition 

• Middle ear infection 
• The common organisms are viral (25%), streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis 

Main features

• Fever, irritability, otalgia and otorrhoea 
• TM: translucency, colour, position and motility
• self-limiting (60% of children treated with placebo became pain-free in 24 hours, and spontaneous resolution AOM occurs in approximately 80% of children)
• According to eTG, diagnosis is likely if there is 
• acute onset of signs and symptoms 
• and a demonstrable middle ear effusion (MEE) characterised by any of the following:
• Bulging of the tympanic membrane
• Limited or absent movement of the tympanic membrane in response to changes in air pressure from a pneumatic otoscope
• An air-fluid level behind the tympanic membrane
• Perforation of the tympanic membrane with otorrhoea 
• Signs and symptoms of middle ear inflammation, characterised by redness of the tympanic membrane
• The incidence of mastoiditis in children with untreated AOM is 1: 1000

Management

• Avoid the routine use of antibiotic therapy for acute otitis media
• Initial antibiotic for all children with systemic features and may be required in children younger than 6 months without systemic features. The treatment recommendations apply regardless whether the tympanic membrane has perforated
• Children without systemic features
• In children aged 6 months or older --> observe, if symptoms persist more than 48 hrs, consider antibiotic treatment
• In children aged younger than 6 months --> treat with antibiotic
• Children with systemic features
• amoxycillin 15 mg/kg up to 500 mg orally, 8 hourly for 5 days
• or (for patients suspected to be non adherent) amoxycillin 30 mg/kg to 1 g orally, 12 hourly for 5 days
• Patients who have an inadequate response to amoxycillin therapy within 48 to 72 hours may have infection caused by a beta-lactamase- producing strain of H. influenza or M. catarrhalis, adding clavulanate provides increased cavity against these pathogens. Use
• Amoxycillin + clavulanate 22.5 + 3.2 mg/kg up to 500 + 125 mg orally, 8 hourly for 5 to 7 days
• For patients hypersensitive to penicillins use 
• cefuroxime (child 3 months to 2 years: 10mg/kg up to 125mg; 2 years or older: 15mg/kg up to 500 mg) orally, 12 hourly for 5 days
• trimethoprim + sulfamethoxazole (child 1 month or older) 4 + 20 mg/kg up to 160 + 800 mg orally, 12 hourly for 5 days 

References

• eTG