Are antibiotics necessary for acute otitis media?
This article has been cited byother articles in PMC. Otitis media is the most common childhood infection for which antibiotics are prescribed. Nonetheless, there are a number of important questions about the optimal management of acute otitis media (AOM), and opinion is divided within the medical community on a range of fundamental issues.
What is the pathophysiology of acute otitis media?
Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia.
What procedures are used to treat acute otitis media (AOM)?
Tympanocentesis and myringotomy are the procedures used to treat AOM. Certain patients require ventilation or drainage of the middle ear cleft for an extended period or have a history of repetitive attacks; these patients benefit from placement of a tympanostomy tube at the time of myringotomy.
What are the signs and symptoms of otitis media (OM)?
Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever. Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection.
What is the drug of choice for otitis media?
High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin.
What is the first-line treatment for acute otitis media?
Amoxicillin at a dosage of 80 to 90 mg per kg per day should be the first-line antibiotic for most children with acute otitis media.
What is the first-line drug for treatment of acute otitis media that is recurrent and appears to have resistant organisms?
Therefore, because of its excellent 'track record' (for infections due to penicillin-susceptible and -resistant bacteria), low cost, safety and acceptability to patients, amoxicillin remains the drug of choice for uncomplicated AOM.
What is otitis media acute?
An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to get ear infections.
Does Augmentin treat otitis media?
Thus far, only five antibiotics—high-dose amoxicillin (80 mg per kg per day), amoxicillin-clavulanate (Augmentin), cefuroxime (Ceftin), cefprozil (Cefzil) and ceftriaxone (Rocephin)—have demonstrated a modest degree (60 to 80 percent) of clinical efficacy in the treatment of acute otitis media caused by penicillin- ...
When do you need antibiotics for acute otitis media?
Antibiotics should be promptly provided if the child's infection worsens or fails to improve within 24 to 48 hours. Guidelines and most ongoing studies support these recommendations.
Which of the following treatments is appropriate for a patient who has acute otitis media and has an allergy to penicillin?
Patients who are allergic to penicillin show 10-15% cross-reactivity when treated with cephalosporins. Levofloxacin has demonstrated higher efficacy in the treatment of AOM than amoxicillin-clavulanate has and can be used in patients who are allergic to penicillin.
Can ciprofloxacin treat otitis media?
Descriptions. Ciprofloxacin and dexamethasone combination ear drops is used to treat ear infections, such as acute otitis externa and acute otitis media. Otitis externa, also known as swimmer's ear, is an infection of the outer ear canal caused by bacteria.
What is OME in otitis media?
Episodes of otitis media should be classified as AOM or otitis media with effusion (OME) Antimicrobials are indicated for treatment of AOM; however, diagnosis requires documented middle ear effusion and signs or symptoms of acute local or systemic illness.
What is the procedure used to treat AOM?
Tympanocentesis and myringotomy are the procedures used to treat AOM. Certain patients require ventilation or drainage of the middle ear cleft for an extended period or have a history of repetitive attacks; these patients benefit from placement of a tympanostomy tube at the time of myringotomy.
How long does it take for a tympanic membrane to heal?
Depending on the size of the hole and the method used to create it, the tympanic membrane usually returns to normal within days to a few weeks.
Why is topical anesthesia necessary for older children?
In most instances, general anesthesia or sedation is necessary in older children because topical anesthesia is relatively ineffective in acutely inflamed tympanic membranes. Numerous tube designs are now available, each with its own weaknesses and strengths with respect to retention, reactivity, and complications.
How long does it take for an effusion free ear to heal?
Mandel showed that when an effusion-free ear was the prime objective, 20 days of antibiotic therapy achieved better outcomes than 10 days of therapy or placebo; however, after 90 days, no difference in the groups existed and recurrence was not prevented by the additional therapy.
Is acute otitis media a self-limiting disease?
Acute otitis media ( AOM) has been described as a self-limiting disease, provided that the patient does not develop a complication. This is an old description that has a renewed relevance. In the new millennium, practitioners are forced to learn the lessons of history because these may serve as our models of practice without effective antimicrobial ...
Is otitis media worse for children?
In a study of 1208 children, aged 6-24 months, Grindler and colleagues concluded that the health-related quality of life in children with recurrent otitis media was significantly worse than it was in healthy youngsters.
What is the most common childhood infection for which antibiotics are prescribed?
Otitis media is the most common childhood infection for which antibiotics are prescribed. Nonetheless, there are a number of important questions about the optimal management of acute otitis media (AOM), and opinion is divided within the medical community on a range of fundamental issues. The purpose of this statement is to address several ...
What is tympanocentesis considered for?
A tympanocentesis should be considered for both therapeutic (relief of pressure and pain) and for diagnostic (recovery of the etiologic agent) purposes. If a tympanocentesis is not practical, consideration should be given to adding amoxicillin-clavulanate or selecting one of the alternative agents from Table 1.
Is parenteral therapy better than oral therapy?
There is, at present, little published evidence that parenteral therapy provides any advantage to the conventional 10-day oral therapy. Furthermore, the use of such broad-spectrum agents may hasten the emergence of antibiotic-resistant organisms.
Is antimicrobial therapy necessary for AOM?
Antimicrobial therapy is one of the cornerstones in the management of AOM but some studies have suggested that its routine use is not indicated (2–4). Because the majority of cases of AOM resolve spontaneously (1), it might appear that antimicrobial therapy is not necessary.