Note: Low grade fever and mild otalgia can frequently persist for up to
48hrs following the initiation of antimicrobiol therapy; If
during the treatment, the patient has severe pain, a marked
febrile course, or bulging of the tympanic membranes, then change
of anti- microbiol therapy is appropriate;
Note:
Ampicillin (Amoxicillin) is the single most useful drug in the therapy of
Acute Otitis Media;
--------------------------------------------------------------------------
Antimicrobiol Drugs for Middle Ear Effusion in Children
Drug/10 day course
Dose (mg/kg/24hr to Adult Upper Limt)
--------------------------------------------------------------------------
Amoxicillin
20-40
x 3 divided doses
Ampicillin
50-100
x 4
"
"
Erthromycin/Sulfisoxazole
50/150
x 4
"
"
Cefaclor
40
x 3
"
"
Trimethoprim and Sulfamethoxazole
8 / 40
x 2
"
"
-------------------------------------------------------------------------
Neonatal (<3 month);
-Predisposing conditions include cleft palate, hypotonia, mental
retardation;
- Neonate/hospitalized: Same as older infants,
-
Enterobacteriaceae (21%), Group B strep.;
- Rx w/
Amoxicillin clavulante or
septra or
Cefuroxime axetil, or
Cefixime; or alternative
Cefaclor;
- If parental needed:
Cefotaxime or
Ampicillin +
Gent;
- Note if afebrile, stable & relatively asymptomatic:
- Rx: with Oral regimen;
- If pt. fails to improve in 48 hrs or develops fever,
need tympanocentesis, parental therapy; Consider LP for sepsis;
Infants, Children, Adults:
- Consider Pneumococci (28%),
H.influenza (21%), B. catarrhalis,
Staph aureus (5%), Group A strep (2-5%), "Steril" (10%);
- Rx: <4yrs:
erythromycin + sulfonamide;
> 4yrs; Rx: Ampicillin/ /sublactam or
septra or
Cefuroxime
or
Cefixime; or alternative:
Cefaclor;
-
Note Tympanocentesis may hasten resolution and decrease sterile
effusion (seen in 70% ofinfants at 14 days after Rx);
Acute w/ Effusion:
Note Endotrach intubation >48hrs; Consider Psuedo sp,
Klebsiella, &
Enterobacter sp.;
Rx:
Ceph III or
Ciprofloxacin or
Imipenem cilastatin or Ticarcillin clavulanate,
or alternative
Aztreonam;
w/ endotracheal intubation >48hrs about 1/3 pts will have otitis media w/ effusion;
Otitis Media Chronic:
Includes recurrent and prolonged episodes of acute;
Etiologies and Rx same as acute; Note; Once a day
Amoxicillin or
sulfisoxazole during winter/spring may decrease frequency of recurrent
disease;
If used, child must be examined every month for effusions;
Tympanostomy tubes may benefit;
--------------------------------------
