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Acute Otitis Media (Middle Ear Infection): Management

by John Fisher, MD
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    00:01 So in terms of our therapy, observation isn’t necessarily bad in a child who’s not that sick because 80% of the patients resolve in two to seven days without any antibiotics.

    00:16 Now, 90% of them resolve with antibiotics, so there is a salutary effect of antibiotics.

    00:24 But there’s certainly no harm in deferring antibiotics for 48 to 72 hours, especially in a patient that you’re not sure, you think they may have just a viral illness.

    00:36 However, those patients obviously should be able to be followed closely.

    00:41 You don’t want to overlook a child who’s deteriorating or a child that might develop meningitis, for example.

    00:49 And then there’s pain control and you can certainly give things like acetaminophen to children.

    00:56 I would generally stay away from ibuprofen, except in maybe adults.

    01:02 And you obviously have to avoid aspirin because of the possibility in children of Reye’s syndrome.

    01:12 So let’s look at what you would choose.

    01:15 Empirically, you’ve got to pick an agent that has activity against the three big bugs-- Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

    01:28 And so, you’re ordinarily going to treat those without a culture.

    01:33 So what you’re going to be choosing for mild to moderate illness would be amoxicillin alone.

    01:42 If it’s more severe, I would use the combination drug amoxicillin/clavulanate and that will pick up some of the organisms that make beta-lactamase.

    01:56 If the patient is truly penicillin allergic, it’s an oral cephalosporin, one of those would be the best choice.

    02:07 Now, in a seriously ill patient where you actually have cultures, then you can design and tailor your therapy accordingly.

    02:15 How long you treat? I like to say to my students the answer is yes.

    02:23 We’re not sure exactly how long to treat.

    02:25 If they’re less than two years of age, we say the magic 10 days.

    02:31 If they’re two to five years of age, five to seven days.

    02:35 But I can tell you this, that in many studies of many infectious diseases, we are finding that fewer days of antibiotic therapy is sufficient, and especially when you think about all the resistant microorganisms that are developing in our world.

    02:52 Shorter duration therapy certainly seems to be prudent if it’s possible.


    About the Lecture

    The lecture Acute Otitis Media (Middle Ear Infection): Management by John Fisher, MD is from the course Upper Respiratory Infections.


    Included Quiz Questions

    1. Defer antibiotics given you are unsure if it is a viral infection at this time and follow up in 48 hours.
    2. Defer antibiotics given you are unsure if it is a viral or bacterial infection and follow up in 1 week.
    3. It is clear he has a viral ear infection, so don't prescribe antibiotics and there is no need for follow up.
    4. It is clear he has a severe bacterial infection, so admit to the hospital for tympanostomy.
    5. It is likely he has a bacterial otitis media, so prescribe a 14 day course of antibiotics.
    1. Acetaminophen
    2. Ibuprofen
    3. Aspirin
    4. APAP/hydrocodone
    5. Lidocaine otic drops
    1. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
    2. Methacillin resistant Staphylococcus, Haemophilus influenzae, and Streptococcus pneumonia
    3. Methacillin resistant Staphylococcus, Haemophilus influenzae, and Moraxella catarrhalis
    4. Streptococcus pyogenes (Group A Strep), Haemophilus influenzae, and Moraxella catarrhalis
    5. Streptococcus pneumoniae, Haemophilus influenzae, and Chlamydophila pneumoniae

    Author of lecture Acute Otitis Media (Middle Ear Infection): Management

     John Fisher, MD

    John Fisher, MD


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