Therapeutics - AOM

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Therapeutics - AOM
2014-10-11 17:55:43
Therapeutics AOM
Therapeutics - AOM
Therapeutics - AOM
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  1. What are the risk factors for Acute otitis media?
    • Biggest risk: age 6 months - 6 years
    • season - winter months (confined spaces)
    • day care attendance
    • pre-existing URI or allergy
    • bottle feeding
    • second hand smoke exposure
    • + family history
    • Having had a previous infection
  2. What are the common organism that cause Acute Otitis Media?
    • Streptococcus pneumonia (35%)
    • H. flu (30%)
    • M. Cattarrhalis (10%)
    • (50% H. flu and 90% M. Cat are Beta-lactamase producing)
  3. What are the clinical manifestations of AOM?
    • Fever – 102-103 temp
    • Earache/tugging at the ear
    • Anorexia
    • Irritability
    • Lethargy
    • hearing loss
  4. What are the potential complications of AOM?
    • Chronic OM
    • Hearing impairment
    • Mastoiditis
    • Perforated tympanic membrane
    • Meningitis
  5. What are the 3 Criteria necessary for an AOM diagnosis?
    • Acute onset of symptoms
    • Middle ear effusion
    • Middle ear inflammation
  6. What are the supportive treatments for AOM?
    • Analgesics:
    • Oral - APAP or IBU 10mg/kg Q4-6
    • Topical – antipyrine + benzocaine (Auralgan)
    • antipyretics – APAP or IBU – same dose as above
  7. Who should receive antibiotics for AOM?
    • Children <6 months should
    • Children ≥ 6 months should receive antibiotics if diagnosis is certain or symptoms are severe (bulging tympanic membrane)
  8. What is the DOC for AOM?
  9. What are the disadvantages of using Amoxacillin (DOC) for AOM?
    • B-lactamase susceptibility is poor and common bugs (H. flu and M. Cat) commonly produce them
    • Increasing penicillin resistance by Streptococcus
  10. What is the normal dose of Amoxicillin for children with AOM?
    • 90 mg/kg/day up to 1500 mg/day
    • Divided bid or TID
    • X10-14 days
  11. What is the expected efficacy of Amoxicillin in the treatment of AOM?
  12. What are the available formulations of Amoxacillin?
    • 125, 250 and 400mg/5 mLs
    • Bubble gum flavored suspension
    • 50 mg/mL
  13. How should you counsel a patient who is taking Amoxicillin for AOM?
    • Take until completely gone
    • Use a dosing cup or graduated spoon
    • SE: Diarrhea and rash
    • Contact prescriber if Diarrhea becomes severe or a rash develops
  14. When is Amoxicillin not indicated for AOM?
    • Treatment with an antibiotic in the last 30 days
    • Concurrent purulent conjunctivitis (indicates a resistant M. Cat strain)
    • Already receiving amoxicillin prophylaxsis
    • Hx of PCN allergy
  15. What are the alternative choices for a patient with AOM (other than Amoxacillin)?
    • Amoxicillin/clavulanate (Augmentin)
    • Cefuroxime axetil (Ceftin)
    • Cefprozil (Cefzil)
    • Cefpodoxime proxetil (Vantin)
    • Cefdinir (Omnicef)
    • Ceftriaxone (Rocefin- IV/IM only)
    • Azithromycin (Zithromax)
    • Clarithromycin (Biaxin)
    • Clindamycin
  16. What is the brand name for Amoxicillin/clavulanate?
  17. What is the brand name for Cefuroxime axetil?
  18. What is the brand name for Cefprozil?
  19. What is the brand name for Cefpodoxime proxetil?
  20. What is the brand name for Cefdinir?
  21. What is the brand name for Ceftriaxone?
  22. What is the generic name for Augmentin?
  23. What is the generic name for Ceftin?
    Cefuroxime axetil
  24. What is the generic name for Cefzil?
  25. What is the generic name for Vantin?
    Cefpodoxime proxetil
  26. What is the generic name for Omnicef?
  27. What is the generic name for Rocefin?
  28. What AOM alternative drugs would you give if a patient has a beta lactam allergy?
    • Azithromycin (Zithromax)
    • Clarithromycin (Biaxin)
    • Clindamycin
  29. What are poor antibiotic choices for AOM?
    • Erythromycin (H. flu resistance = high)
    • First generation Cephalosporins: Cephalexin (Keflex) and Cefadroxil (Duracef)
    • Ceftibuten (Cedax) (high streptococcus resistance)
    • Trimethoprim/sulfamethazole (Bactrim or Septra) (high streptococcus resistance)
  30. How long should you treat a child on a traditional AOM antibiotic regimen?
    • Traditional duration – 10 to 14 days
    • Mild to moderate severity and at least 6 years of age may be treated for 5 days
  31. How long should you treat a child on Azithromycin for AOM?
    Minimum 3 days
  32. What are the preventative measures for avoiding AOM?
    • Reduce risk factors
    • Vaccinate for H. flu B and influenza
    • Surgery
  33. What is the time frame for improvement expected with AOM treatment?
    • 24-48 hours
    • Beyond that, see a physician
  34. How can treatment failures for AOM be resolved?
    • Change antimicrobial with better beta-lactamase or pen resistant strep activity
    • Tympanocentesis/myringotomy
    • Continue antibiotics for 10 days – 2 weeks
    • Watch without antibiotics
    • tympanostomy tubes
    • Culture purulent fluid (if present)
  35. A patient has failed on Amoxacillin for the treatment of AOM, what antibiotics would you look to switch to and why?
    • 2nd or 3rd generation cephalosporin or Augmentin
    • Need more H. flu coverage
  36. What is the brand name for Azithromycin?
  37. What is the brand name for Clarithromycin?
  38. What is the generic name for Zithromax?
  39. What is the generic name for Biaxin?