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Pharm I Fall 2011
Treatment AOM
| Question | Answer |
|---|---|
| Most common Dz childhood illness | AOM |
| MC reason for Abx Rx in kids | AOM |
| What % is viral cultured in nasopharyngeal secretions? | 42% patients w/OM |
| Bacterial pathogens | s. pneumoniae H. influenza M. Cat |
| What % resistant w/ S. pneumoniae? | 35% - alteration PBP |
| Who has higher prevalence reisistant S. pneumo? | Child <2 yo Child daycare Child w/ abx treatment w/in preceding 3 months |
| What percent h flu beta lactamase producing? | 30% - combo drug needed |
| what percent m cat beta-lactamase producing? | 100% |
| Recommendation 1 for AOM | DX AOM: 1. Hx acute onset 2. Signs MEE 3. Signs/Sx Middle ear inflammation |
| Presence MEE indicated by | bulging TM Limited/absent mobility TM Air-fluid level behind TM Otorrhea |
| Signs/Sx Middle Ear inflammation | distinct erythema TM distinct otalgia |
| Recommendation 2 for AOM | include assessment of pain pain present - recommend treatment to reduce pain |
| Mainstay of pain management for AOM | Acetaminophen 10-15mg/kg q4-6hr Ibuprophen 5-10 mg/kg q6-8hr |
| Recommendation 3 AOM | observation without use antibacterial agents in child w/uncomplicated AOM is option |
| Observation without use of antibacterial agents is based on what? | diagnostic certainty, age, illness severity, and assurance of follow up |
| <6 mo w/certain and uncertain diagnosis AOM | Antibacterial therapy indicated |
| 6 mo to 2 yr certain diagnosis and uncertain diagnosis w/SEVERE illness | antibacterial therapy indicated |
| 6 mo to 2 yr w/ uncertain dx w/nonsevere illness | OBSERVATION |
| >2 y certain dx w/severe illness | antibacterial therapy |
| >2 y certain dx w/nonsevere illness, uncertain diagnosis | OBSERVATION |
| Antibiotic selection based on what? | coverage pathogens, available formulations, cost, frequency dosaes, concominant dz states, patient age, AE, bacterial resistance patterns, pt allergy, taste, recent abx therapy |
| Recommendation 3B | Treat w/Antibacterial agent, clinician prescribe amoxicillin - 80-90 mg/kg/day / BID |
| Recommendation 4 | Patient fails to respond to initial management option w/in 48-72 hrs, clinician reassess pt to confirm AOM and exclude other causes illness |
| if AOM confirmed w/patient initially managed w/observation switch to? | Antibacterial |
| if patient initially managed w/antibacterial agent switch to? | CHANGE antibacterial agent |
| Duration treatment <6 years old or children w/severe dz | 10 days |
| duration treatment >/= 6yo w/ mild to mod dz | 5-7 days |
| ear effusions last how long? | 2-4 weeks |
| Recommendation 5 | clinicians should encourage prevention of AOM thru reduction of risk factors |
| Risk factors shown to decrease incidence of AOM significantly | alter child care attendance patterns breastfeed for at least first 6 months |
| what percentage decrease of AOM w/influenza vaccine | 30% |
| Recommendation 6 | no recommendations for CAM for Tx of AOM based on limited and controversial data |
| Recurrent OM defined as? | >/= 3 AOM epsidoes w/in 6 months or 4 episodes w/in 12 months 1 in 3 children w/AOM suffer recurrent infx |
| Antibiotic Prophylaxis | Generally NOT recommended - major contributor to emergence of DRSP |
Created by:
ashleylafontaine
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