MANAGING OTITIS MEDIA: STRATEGIES FOR PHARMACY TEAMS
L. Austin Fredrickson, MD, FACP
L. Austin Fredrickson, MD, FACP, is an Associate Professor of Internal Medicine at Northeast Ohio Medical University, where he serves as core faculty and teaches diagnostics, therapeutics, clinical skills, and health humanities. He is board-certified in general internal medicine and practices rural primary care.
Topic Overview
Otitis media, or middle ear inflammation, presents unique challenges in clinical management, necessitating a comprehensive understanding of its pathophysiology, diagnostic methods, and evidence-based treatment approaches. Otitis media is not a single condition but includes a range of diseases, including acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media (CSOM). As members of interprofessional care teams, pharmacists should understand the clinical presentation and evaluation of patients with otitis media and recommended treatment strategies. This continuing education presentation is designed to enhance the pharmacy team’s knowledge of the care of patients with otitis media. It will review the pathophysiology, etiology, epidemiology, differential diagnosis, and complications of otitis media. Treatment strategies will also be discussed, including mechanisms of action, dosing, and side effects of antibiotic therapies.
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RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is
Pharmacist 0669-0000-24-079-H01-P
Pharmacy Technician 0669-0000-24-080-H01-T
Credits: 1.5 contact hour(s) (0.15 CEU(s)) of continuing education credit
Type of Activity: Knowledge
Media: Internet/Home study Fee Information: $5.99
Estimated time to complete activity: 1.5 contact hour(s) (0.15 CEU(s)), including Course Test and course evaluation
Release Date: July 2, 2024 Expiration Date: July 2, 2027
Target Audience: This educational activity is for pharmacists and pharmacy technicians
How to Earn Credit: From July 2, 2024, through July 2, 2024, participants must:
Read the “learning objectives” and “author and planning team disclosures;”
Study the section entitled “Educational Activity;” and
Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)
Credit for this course will be uploaded to CPE Monitor®.
Learning Objectives: Upon completion of this educational activity, participants should be able to:
Describe the pathophysiology of and risk factors for otitis media
Identify the clinical presentation of otitis media, including common signs and symptoms
Compare and Contrast treatment strategies for the management of otitis media
Disclosures
The following individuals were involved in developing this activity: L. Austin Fredrickson, MD, FACP, and Pamela Sardo, PharmD, BS. Pamela Sardo and L. Austin Fredrickson have no conflicts of interest or financial relationships regarding the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.
©RxCe.com LLC 2024: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of RxCe.com LLC.
Educational Activity
Managing Otitis Media: Strategies for Pharmacy Teams Introduction
Otitis media, or middle ear inflammation, presents unique challenges in clinical management, necessitating a comprehensive understanding of its pathophysiology, diagnostic methods, and evidence-based treatment approaches using the American Academy of Pediatrics guidelines. As members of interprofessional care teams, pharmacists and pharmacy technicians should understand the clinical presentation and evaluation of patients with otitis media and recommended management strategies. This knowledge will assist with evaluating and referring patients with ear pain to their primary care provider. This continuing education presentation is designed to enhance the pharmacy team’s knowledge of the care of patients with otitis media. It will review the pathophysiology, etiology, epidemiology, differential diagnosis, and complications of otitis media. Treatment strategies will also be discussed, including mechanisms of action, dosing, and side effects of antibiotic therapies.
Otitis Media: Terms and Definitions
Otitis media terms are defined in Table 1.1 Each condition is described in more detail below.1 A thorough understanding of this terminology is important, as these conditions are closely related.1
| Term | Abbreviation | Definition |
| Otitis Media | OM | Inflammation of the middle ear (nonspecific term) |
| Acute Otitis Media | AOM | Rapid onset of signs and symptoms of inflammation in the middle ear |
Table 1 Otitis Media Definitions1
| Recurrent AOM | -- | Three or more documented and separate AOM episodes in the last 6 months or four or more episodes in the last 12 months with more than one episode in the past 6 months |
| OM with effusion | OME | Fluid in the middle ear without signs or symptoms of acute ear infection |
| Chronic OME | --- | OME that persists for three or more months from the date of onset (if known) or from the date of diagnosis (if onset is unknown) |
| Chronic suppurative OM | CSOM | Chronic inflammation of the middle ear and mastoid mucosa with a non-intact tympanic membrane and persistent ear discharge |
| Middle ear effusion | MEE | Fluid in the middle ear from any cause |
Acute Otitis Media
Acute otitis media includes the signs and symptoms of an acute infection and fluid in the middle ear.1 This condition can occur recurrently, leading to frequent ear pain and discomfort for children.1 Complications of AOM can be serious and include meningitis, mastoiditis, and brain abscesses; however, these complicating issues are generally rare.1 Hearing loss may result either because of the illness or as a complication of treatment with tympanostomy tubes.1
Otitis Media with Effusion
Otitis media with effusion is similar to AOM but does not include signs and symptoms of acute infection.1 An estimated 80% of children will have an episode of OME by the age of 10, making it a common pediatric disorder.1 The most common symptom associated with OME is conductive hearing loss, which results from impaired sound wave transduction due to middle ear effusion
(MEE).1 Otitis Media with effusion is a risk factor for AOM.1 It is a condition that may be seen on physical examination even in asymptomatic patients.
Chronic Suppurative Otitis
Chronic suppurative otitis media is inflammation of the middle ear and mastoid mucosa with a non-intact tympanic membrane and persistent ear discharge. This can and often does lead to conductive hearing loss. Chronic suppurative otitis media increases patients' risk of permanent sensorineural hearing loss.1 The most common symptom is persistent or recurrent ear discharge through a ventilation tube or perforated tympanic membrane.1
Epidemiology and Etiology
The estimated incidence of AOM is 10.8 new episodes per 100 people per year.1 There are approximately 709 million new AOM episodes annually, with 51% occurring in children under age five.1 Most children experience at least one OME episode by age three, and by the age of 6, almost 60% of children will have experienced at least one episode of AOM.1,2
The highest global AOM incidence occurs among children aged 1–4 years (61 new episodes per 100 children per year).1 Otitis media with effusion is often asymptomatic and hard to detect accurately or may present with nonlocalized, vague symptoms in young patients. Many occur before infants or toddlers can effectively communicate or even point to or grab at the affected ear.1
Chronic suppurative otitis media has an average global incidence of 4.8 new episodes per 1,000 people yearly, totaling 31 million new episodes annually, with 22% in children under age five.1 Risk factors for OM are detailed in Table 2.1
Table 2
Risk Factors for OM1
| Risk Factors |
| Host Risk Factors |
| Young age |
| Male sex |
| Race and ethnicity |
| Genetic factors and family history |
| Craniofacial anomaly |
| Atopy |
| Immunodeficiency |
| Upper respiratory tract infections (URTIs or URIs) |
| Adenoid hypertrophy |
| Laryngopharyngeal reflux |
| Environmental Risk Factors |
| Low socioeconomic status |
| Tobacco smoke exposure |
| Having older siblings |
| Day-care attendance |
| Use of a pacifier |
| Lack of breastfeeding |
| Malnutrition (in developing countries) |
Pathophysiology
In developed countries, otitis media is typically uncomplicated and self- limiting, and it does not usually cause hearing problems or developmental delays.1 Lifelong issues that result from OM are more common in high-risk populations.1 The progression of OM involves exposure to various social, environmental, and genetic risk factors, especially tobacco exposure and patients who are contagious for upper respiratory diseases. The disease begins with early and dense bacterial colonization of the nasopharynx, leading to early-onset AOM, which triggers an acute inflammatory cycle in the middle ear.1 This inflammation is perpetuated by bacterial persistence through biofilm formation, viral infections, and eventual severe chronic ear disease when untreated or improperly treated.1
Understanding the anatomy of the Eustachian tube (less commonly referred to as the pharyngotympanic tube) can assist pharmacists in grasping the underlying pathophysiology of OM.1 The role of the eustachian tube is to protect the middle ear from pathogens, drain secretions, and equalize pressure.1 The tube's epithelial cells, which produce antimicrobial proteins and mucus, help protect against bacterial colonization. Infants have immature tubes, which makes them more susceptible to middle ear infections.1 In infants, the tube is shorter, wider, and more horizontal, allowing pathogens to be transmitted more easily.1 Over time, as patients grow and mature, the eustachian tube elongates, and its angle steepens, which reduces the risk of OM.1
The risk of OM is increased by nasopharyngeal colonization with bacterial pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.1 The prevalence and strain dominance of these pathogens vary by geography and pneumococcal conjugate vaccine use. Bacterial biofilms, which protect bacteria from antibiotics and the immune response, are found in CSOM and persistent OME.1 Such biofilms contribute to the antibiotic resistance of OM.1
Acute otitis media is nearly always preceded by viral infections, such as the common cold, which initiate inflammation in the nasopharynx and Eustachian tube.1 Viruses like RSV, rhinovirus, and influenza alter mucosal immunity, increase bacterial adherence, and impair mucociliary clearance, leading to Eustachian tube dysfunction and middle ear infections.1 The presence of both bacteria and viruses in the middle ear exacerbates inflammation and reduces antibiotic effectiveness.1 In one study, the rate of AOM and OME in children between the ages of 6 and 47 months following URTI was 37% and 24%, respectively.3
Clinical Presentation and Diagnosis
The proper diagnosis of OM requires an accurate patient history and a thorough physical exam.1 Table 3 presents common signs and symptoms. It can be challenging to diagnose OM based on symptoms alone. Some children
may present with no symptoms at all or have symptoms that seem indicative of other illnesses, such as clumsiness, poor performance in school, or restless sleep.1 However, ear pain is present in up to 60% of children with AOM. Very young children may not be able to verbalize this pain and instead may show signs of ear rubbing or holding or undergo behavioral changes such as sleep or persistent crying.1
Table 3
Signs and Symptoms of Otitis Media2,4
| Category | Sign/Symptom | Description |
| Symptoms of AOM | Ear pain | A common symptom, useful for diagnosis; present in 50- 60% of children with AOM |
| Fever | It often accompanies ear pain and can be a sign of AOM. | |
| Irritability | Children may be irritable due to discomfort. | |
| Otorrhea | Ear discharge, indicating the presence of infection. | |
| Anorexia | Decreased appetite due to discomfort or infection. | |
| Signs of AOM | Bulging tympanic membrane (TM) | Highly indicative of AOM, associated with bacterial presence. |
| Inflamed, cloudy TM with obscured landmarks | Suggestive of infection, often seen in AOM cases. | |
| Immobility of TM | Identified via pneumatoscopy, Valsalva maneuver, or swallowing while holding the nose shut | |
| Conductive hearing loss | Due to middle ear fluid or TM immobility. | |
| Severe Signs | Moderate to severe otalgia | Significant ear pain lasting at least 2 days. |
| Temperature >102.2°F | High fever accompanying ear pain. | |
| Young Children | Tugging/rubbing/holding of the ear | Indicative of ear pain in preverbal children. |
| Excessive crying | A non-specific symptom that is often seen with AOM. |
| Changes in sleep or behavior pattern | Noted by parents, often indicative of discomfort or pain. |
To diagnose AOM or OME, middle ear effusion (MEE) must be present.
Useful diagnostic modalities are summarized in Table 4.1
Table 4 Diagnostic Modalities for OM1
| Diagnostic Modality | Description |
| Otoscopy | The main diagnostic tool for AOM involves visualizing the tympanic membrane and assessing its color, opacity, position, and integrity. This requires removing the cerumen for an accurate view. |
| Pneumatic Otoscopy | The primary method for diagnosing OME is by assessing tympanic membrane mobility, which helps differentiate OME from AOM and normal ear conditions. |
| Otomicroscopy | Useful for diagnosing OME and assessing tympanic membrane abnormalities such as perforation and retraction pockets. Requires special equipment and training. |
| Tympanometry | Measures tympanic membrane mobility and middle ear function; provides objective data on middle ear pressure and volume, aiding in the diagnosis of OME. |
| Acoustic Reflectometry | Measures sound reflection off the tympanic membrane. Higher reflectivity indicates a higher probability of MEE. Parents can use it for monitoring. |
| Symptom Severity Scales for AOM | Parent-reported scales such as AOM Severity of Symptoms Scale (AOMSOS) and AOM Faces Scale (AOM-FS) assess severity based on symptoms like ear pain, fever, and irritability |
Per the AAP guidelines on otitis media, AOM should be diagnosed in children with moderate or severe bulging of their tympanic membrane or if they have a new onset of otorrhea not due to acute otitis externa.4 Additionally, AOM should be diagnosed in children with mild TM bulging and ear pain or intense erythema of the TM that started within the previous 48 hours.4 Acute otitis media should not be diagnosed in children who do not have MEE, either based on pneumatic otoscopy or tympanometry.4 Besides assessing for AOM, clinicians should assess the patient’s pain level. If pain is present, options for analgesia should be provided.4
Prevention of OME
Preventing OME involves multiple strategies to reduce modifiable risk factors, including bacterial infections. Vaccination plays a crucial role, with pneumococcal conjugate vaccines (originally PCV 7 and PCV 13 but now PCV 15 and PCV 20) significantly reducing acute otitis media (AOM) caused by specific pneumococcal serotypes and decreasing the need for ventilation tubes.1 Although PCVs can replace vaccine-covered serotypes with non- vaccine types, overall pneumococcal-associated AOM rates continue to decline.1 Influenza vaccines also reduce AOM incidence by preventing influenza-related upper respiratory tract infections (URTIs), which are common precursors to AOM.1
Non-vaccine approaches include early antiviral treatment during URTI episodes and using immune modulators like Echinacea.1 Echinacea is an immune modulator and a mild antiviral agent that may reduce the risk of OM.1 While xylitol and probiotics often advertise their ability to reduce respiratory infections and OM, their practical application needs further research.1 Environmental risk factors such as tobacco smoke exposure, pacifier use, and day-care attendance should be minimized, especially during the peak incidence age of 6-24 months.1
Breastfeeding exclusively for six months offers significant protection against OM. Parents are encouraged to avoid supine bottle feeding and seek smaller childcare groups to reduce infection risk.1
Pharmacists and pharmacy technicians can educate patients and caregivers about these prevention strategies. They can provide information on the importance of vaccinations, recommend early antiviral treatments, and advise on lifestyle modifications to minimize environmental risks. In doing so, both professionals play a vital role in preventing OME and improving overall child health.
Treatment of OME and Other Illnesses Acute Otitis Media (AOM)
The primary treatment for AOM focuses on symptomatic relief using analgesics like acetaminophen and ibuprofen to manage ear pain and fever.1 While oral antibiotics can shorten the duration of symptoms and prevent MEE, their use should be weighed against potential side effects and the risk of antimicrobial resistance.1 While antibiotics may help lessen pain by day 2 or 3 of treatment, many children experience adverse effects that include vomiting, diarrhea, and rash.2
In contrast, analgesics relieve pain much more quickly and should be continued as long as needed.4 Pain reduction is specifically recommended by the AAP guidelines.4
Fortunately, AOM resolves the problem without antibiotics in up to 80% of children.2 Antibiotic usage tends to be more beneficial in patients under age two with bilateral AOM and in children of all ages who present with ear discharge because of AOM. Antibiotics are also recommended for children under six months, those with severe AOM, or those with immunocompromised conditions.1
Indications for antibiotic treatment of AOM by age are summarized in Table 5.2
Table 5
Indications to Use Antibiotics in the Treatment of AOM2
| Agee | Indication |
| <6 months | Antibiotic treatment is reasonable for all |
| 6 months to 2 years | Bilateral ear findings |
| ≥6 months | Otorrhea |
| >2 years | Symptoms worsening or not improving within 48–72 h |
| All ages | Ear findings with severe otalgia, otalgia lasting at least 2 days, or temperature of >102.2°F |
Per AAP guidelines, children six months and older with severe signs or symptoms, such as moderate-severe otalgia or otalgia for 48 hours, should be prescribed antibiotics for AOM.1 This includes bilateral or unilateral AOM. Young children between the ages of 6 and 23 months old with non-severe bilateral AOM should be prescribed antibiotics even without severe signs or symptoms.1 Antibiotic therapy or observation can be offered to children between the ages of 6 and 23 months with non-severe unilateral AOM without severe signs or symptoms.1 This choice should be made in conjunction with the patient’s caregivers.1 If observation is selected, follow-up must be ensured, and antibiotic therapy started in the child either worsens or does not improve within 72 hours of symptom onset.1
For non-severe AOM in children aged 24 months or older without severe symptoms, clinicians should prescribe antibiotics or offer observation with close follow-up based on joint decision-making with the parents or caregivers.1 If observation is chosen, follow-up is essential to start antibiotics if the child's condition worsens or does not improve within 48 to 72 hours.1
When antibiotics are needed, amoxicillin is the antibiotic of choice if the child has not received it in the past 30 days, does not have purulent conjunctivitis, and is not allergic to penicillin.1 Antibiotic doses are detailed in Table 6. Amoxicillin is dosed at 90 mg/kg (up to 3000 mg).2 Children under the age of 2 should receive antibiotics for 10 days.1 Children between the ages of 2-5 with mild to moderate AOM should take antibiotics for 5-7 days, and
children 6 years and older with mild or moderate symptoms should receive treatment for 5 days.2
Table 6
Antibiotics for the Treatment of Acute Otitis Media5
| Antibiotic | Brand Name | Dose | Comments | |
| Initial Diagnosis | ||||
| Amoxicillin | Amoxil® | 80-90 mg/kg/day orally divided twice daily | First-line | |
| Amoxicillin- clavulanate | Augmentin® | 90 mg/kg/day orally of amoxicillin plus 6.4 mg/kg/day orally of clavulanate, divided twice daily | First-line if certain criteria are present | |
| Cefdinir, Cefuroxime, Cefpodoxime | Omnicef®, Ceftin®, Vantin® | Cefdinir (14 mg/kg/day orally in 1-2 doses), Cefuroxime (30 mg/kg/day orally divided in two daily), Cefpodoxime (10 mg/kg/day orally divided in two daily doses) | Second-line or nonsevere penicillin allergy | |
| Ceftriaxone | Rocephin® | 50 mg/kg/day IM or IV once daily for 3 days | Second-line or nonsevere penicillin allergy | |
| Failure at 48-72 Hours | ||||
| Amoxicillin- clavulanate | Augmentin® | 90 mg/kg/day orally of amoxicillin plus 6.4 mg/kg/day orally of clavulanate, divided twice daily | First-line | |
| Ceftriaxone | Rocephin® | 50 mg/kg/day IM or IV once daily for 3 days | First-line or nonsevere penicillin allergy | |
For children with recent amoxicillin treatment, purulent conjunctivitis, or recurrent AOM unresponsive to amoxicillin, an antibiotic with additional β- lactamase coverage should be prescribed.1 Patients could be prescribed amoxicillin/clavulanate (90/6.4 mg/kg per day) divided into two doses.2
Alternative options include cefdinir, cefuroxime, or ceftriaxone.2 If symptoms worsen or do not respond within 48 to 72 hours, clinicians should reassess the patient and consider changing the therapy.2
It is uncommon for adults to have AOM, but it can be treated with antibiotics if present.2 As with children, the drug of choice is amoxicillin.2 If more than two episodes of AOM occur within a year, the patient should be referred to a specialist.2
Recurrent AOM
Prophylactic antibiotics are not recommended to reduce recurrent AOM episodes, but tympanostomy tubes may be considered for recurrent AOM.1 Clinicians should recommend pneumococcal conjugate and annual influenza vaccines as per CDC, AAP, and AAFP schedules, promote exclusive breastfeeding for at least six months, and advise avoiding tobacco smoke exposure.1 Preventive strategies for recurrent AOM include immunization with PCVs, though these vaccines are less effective once recurrent AOM is established.1 Antibiotic prophylaxis can reduce recurrences but is generally not recommended due to the risks of long-term antibiotic use, including the development of side effects and antibiotic resistance.1 Ventilation tubes may be considered for children with persistent MEE in one or both ears. At the same time, adenoidectomy (surgical removal of the adenoids) can help in cases with nasopharyngeal obstruction or recurrent AOM.1 Pharmacists and qualified pharmacy technicians can provide information on vaccination schedules and their importance and answer patient or caregiver questions.
OME
Management of OME primarily aims to restore hearing.1 Most cases resolve spontaneously within a few months, so a watchful waiting period is recommended.1 It is not usually warranted to use medication therapies such as decongestants, antihistamines, and corticosteroids as they often do not work and instead lead to adverse reactions.1 Ventilation tubes may be considered if hearing loss persists beyond three months.1 Adenoidectomy can
be beneficial for children aged four and older with persistent OME.1 Hearing aids are an option for those in whom surgery is not feasible.1
Ventilation Tube-Associated Ear Discharge
For some patients with complications or recurrence, ear tubes (called tympanostomy tubes), ventilation tubes, myringotomy tubes, or pressure equalization tubes are recommended. These hollow tubes perforate the tympanic membrane and allow air to ventilate the middle ear and fluid from building up behind the membrane. Children with ventilation tubes often experience episodes of ear discharge, which can be managed with antibiotic ear drops.1 The incidence of acute ear discharge has been estimated to be anywhere between 26-75% and often results in symptoms of pain, fever, unpleasant odors, and patient concern.1 Quinolone ear drops are preferred for management due to their low risk of ototoxicity.1 Perioperative interventions like saline washouts and antibiotic applications during tube surgery are beneficial for preventing postoperative ear discharge.1 Pharmacists can recommend appropriate ear drops and explain their proper use.
Chronic Suppurative Otitis Media (CSOM)
Topical quinolone antibiotics are effective in managing CSOM-related discharge.1 Combining systemic and topical antibiotics is not more effective than topical treatment alone.1 Surgical interventions to repair tympanic membrane perforations can improve outcomes.1
The Role of the Pharmacy Technician
Pharmacy technicians are crucial in assisting pharmacists in providing care for patients seeking treatment for ear pain. Technicians can also educate patients on the importance of completing prescribed antibiotic courses and provide instructions on proper medication administration. Additionally, they can assist in preparing and labeling medications, ensuring that prescriptions are accurate and ready for pharmacist review. By managing inventory and ensuring the availability of commonly prescribed treatments for otitis media,
Additional Resources:
AAP Guidelines4
https://publications.aap.org/pediatrics/article/131/3/e964/30912/The- Diagnosis-and-Management-of-Acute-Otitis-Media
such as analgesics and antibiotics, pharmacy technicians help streamline the workflow. This collaborative approach enhances patient care by providing timely and efficient service, ultimately improving health outcomes for those suffering from ear pain and otitis media.
Summary
Otitis media, characterized by middle ear inflammation, presents various challenges in clinical management, requiring a thorough understanding of its pathophysiology, diagnostic methods, and evidence- based treatment strategies. This condition encompasses a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media (CSOM). Pharmacists and pharmacy technicians play a crucial role in interprofessional care teams by understanding the clinical presentation and evaluation of otitis media, which helps in appropriately evaluating and referring patients with ear pain to primary care providers.
Course Test
Which of the following terms refers to the rapid onset of signs and symptoms of inflammation in the middle ear?
Middle Ear Effusion (MEE)
Otitis Media with Effusion (OME)
Chronic Suppurative Otitis Media (CSOM)
Acute Otitis Media (AOM)
Which of the following conditions most increases the risk for permanent sensorineural hearing loss?
Acute Otitis Media (AOM)
Otitis Media with Effusion (OME)
Chronic Suppurative Otitis Media (CSOM)
Recurrent Acute Otitis Media
A 10-month-old male presents with recurrent ear infections. He sleeps in the same room as his 10-year-old brother, who does not. Compared to his older brother, what anatomical characteristic of the infant patient makes him more susceptible to middle ear infections?
Shorter, wider, and more horizontal Eustachian tubes
Longer, narrower, and more vertical Eustachian tubes
Immature nasal passages
Smaller auditory canals
A parent brings in their child who is complaining of ear pain and asks if their child has an ear infection. Which of the signs listed MUST be present to diagnose AOM or OME?
High fever
Otorrhea
Middle ear effusion (MEE)
Enlarged lymph nodes
According to the AAP guidelines, what is the recommended treatment approach for children six months and older who present with severe signs or symptoms of AOM?
Observation with close follow-up
Analgesics only
Oral antibiotics
Surgical intervention
A 12-month-old female is brought in by her grandmother and diagnosed with AOM. She has not had any antibiotics in the last month, has no conjunctivitis, and has no known allergies. What is the first-line antibiotic for treating her?
Cefdinir
Amoxicillin
Azithromycin
Amoxicillin-clavulanate
For children with recent amoxicillin treatment, purulent conjunctivitis, or recurrent AOM unresponsive to amoxicillin, which of the following is the best antibiotic to recommend?
Amoxicillin-clavulanate
Cefdinir
Cefuroxime
Ceftriaxone
A mother regularly visits the pharmacy to pick up antibiotics for her children, who have had multiple ear infections in the last year. Which of the following is the best advice for the patient that may help reduce the incidence of further ear infections?
Prophylactic antibiotics
Pneumococcal conjugate and influenza vaccines
Antihistamines and decongestants
Increased exposure to smoke
A 6-year-old boy received ventilation (or tympanostomy) tubes 2 months ago and is presenting with disgusting ear discharge. Which of the following is the best treatment to recommend for this patient due to the low risk of ototoxicity?
Oral antibiotics
Decongestants and antihistamines
Quinolone ear drops
Systemic corticosteroids
Which of the following strategies should NOT be recommended in managing otitis media with effusion (OME)?
Watchful waiting for mild cases with anti-inflammatory/analgesia
Ventilation tubes for persistent hearing loss
Oral antibiotics for infants less than 6 months old
Routine use of decongestants and antihistamines
References
Schilder AG, Chonmaitree T, Cripps AW, et al. Otitis media. Nat Rev Dis Primers. 2016;2(1):16063. Published 2016 Sep 8. doi:10.1038/nrdp.2016.63
Amdur RL, Linder JA. Upper Respiratory Symptoms, Including Earache, Sinus Symptoms, and Sore Throat. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. eds. Harrison's Principles of Internal Medicine, 21e. McGraw-Hill Education; 2022.
Chonmaitree T. Viral upper respiratory tract infection and otitis media complication in young children. Clin. Infect. Dis. 2008;46:815–823. doi: 10.1086/528685.
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media [published correction appears in Pediatrics. 2014 Feb;133(2):346. Dosage error in article text]. Pediatrics. 2013;131(3):e964-e999. doi:10.1542/peds.2012-3488
Lee GC, Frei BL, Frei CR. Upper Respiratory Tract Infections. In: DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod VL, Posey L. eds. DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill; 2023.
DISCLAIMER
The information provided in this course is general in nature, and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.
Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.
Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby.
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©RxCe.com LLC 2024: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of RxCe.com LLC.