Acute Otitis Media (Middle Ear Infection): Management

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 In patients who received bata-lactam in the last 30 days or on those with concomitant conjunctivitis, 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.