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Otitis media

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