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Otitis Media and Pharyngitis
Saumil Patel, PharmD, BCPS
8
Pharmacology
Professional
09/02/2013
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Term
Appropriate Diagnosis
 Definition
Specific, stringent definition of AOM

Presence of moderateto severeTM bulging

Presence of mild TM bulging PLUS

recent (< 48 hours) onset of ear pain

intense erythema of the TM

New onset of otorrhea notdue to AOE
 Distinguishing AOM From OME
 ØMEE = ØAOM diagnosis
Term
Initial AOM Diagnosis Management
 Definition
Initial observation
vs. antibiotic
treatment
 Appropriate choices of antibiotic agents
 Treatment of otalgia
Term
Severe AOM
(bilateral or unilateral)
 Definition

Age > 6 months
signs or symptoms include either
moderate or severe otalgia
otalgia > 48 hours
 temperature > 39°C (102.2°F)
Term
Non-severe Bilateral AOM
 Definition
Initiate Antibiotic Therapy
 Severe AOM
(bilateral or unilateral)

Age > 6 months

Signs or symptoms include either

moderate or severe otalgia

otalgia > 48 hours

temperature > 39°C (102.2°F)
 Non
Non-severe Bilateral AOM
Term
Non-severe Unilateral AOM PLUS
age 6 6-24 months
 Definition
Provide symptomatic relief

Observation with close follow-up base on joint decision-making with the parent(s)/caregiver for unilateral AOM

MUST have ability for follow-up

initiate antibiotic therapy if the child worsens or fails to improve within 48 to 72 hours of onset of symptoms
Term
Safety Net Prescriptions
 Definition
“Wait-and-see prescription,”

Parent/caregiver is given an antibiotic prescription

ONLY to be filled if:

child fails to improve within 2 to 3 days

symptoms worsen at any time

Consider pain medication
Term
“Call or return return”
 Definition
ONLY for non-severe unilateral AOM

Parents/Caregivers to call or return:

if the child fails to improve within 2 to 3 days

if symptoms worsen

Consider pain medication

Rescue antibiotic if needed
Term
AOM
– 1st st Line Treatments
 Definition
Continued
Δ in antibiotic susceptibility
 ↑ multi multi-drug resistant organisms (MDRO)
 Standard amoxicillin dosing =
↓ effectives
 40 mg/kg/day
 DOC =
amoxicillin for confirmed diagnosis AND AND:
 Ø amoxicillin exposure in last 30 days
 Ø concurrent purulent conjunctivitis
 Ø penicillin allergy
Augmentin
for confirmed diagnosis AND AND:
 amoxicillin exposure in last 30 days
 concurrent purulent conjunctivitis
 Hx of recurrent AOM unresponsive to
amoxicillin
 Desired c
coverage

β-lactamase–positive H. influenzae

M. catarrhalis
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