-
Otitis Anti-Infectives
- If not allergic to PCN:
- Amoxicillin - drug of choice
- Augmenten (amoxicillin + Clavulanate) for more severe cases
- If allergic (mild Rxn) to PCN:
- Broad spectrum PCNs (Acillins)
- cefdinir (Omnicef)
- ceftriaxone (Rocephin)
- If allergic (severe Rxn) to PCN:
- Macrolides (broad-spectrum) (mycins):
- azithromycin (Zithromax)
- clarithromycin (Biaxin)
- erythromycin
- clindamycin
-
SE of Augmentin (amoxicillin + clavulanate)
-
Treatment plan for otitis media
- < 6 months - antibiotics immediately
- > 6 months - wait 48 hours to see if self-resolving
- > Risk pts - treat immediately
- Try not to use antibiotics
-
AOM diagnosis
Certain - Requires ALL of the following
Uncertain - May not have ALL of the symptoms
- Rapid onset of signs/symptoms
- Middle ear effusion w/pain, bulging
- Middle ear inflammation
-
Severe vs. nonsevere otitis media
- Severe:
- Moderate to severe ear pain or fever > 39deg C
- Nonsevere:
- Mild ear pain or fever 30deg C
-
Otitis Media S/S
- Ear pain/fullness, hrg impairment
- Child irritable, tugging ear, dist. sleep/eat patterns
- Fever UNCOMMON
- Purulent drainage, red, bulging tympanic membr
-
Choices for resistant Otitis Media
- Augmentin
- Omniceph
- Rocephen
If not improved in 48 - 72 hours.
-
Prevention of Otitis Media
- Risk factors: daycare, pacifier, <2yo, recent abx in 3 months
- Immunizations: influenza vacc = 30% reduction
- Pneumonia vaccine = 6% reduction
-
Otitis Externa Risk Factors
- Excessive cleaning - Q tips
- Scratching
- Swimming
- Hearing aids, headphones, ear plugs
-
S/S Otitis Externa
- Acute pain
- Itching
- Inflammation
- Watery discharge
- Hearing loss
-
Tx Otitis Externa
- Clean the ear canal (water/saline - not Q tips)
- Acetic Acid - prevents growth of psuedomonas and staph
- Hydrocortisone (inflammation/pain)
- Topical antibiotics
-
Otitis Externa Topical Antibiotics
- Aminoglycosides: Gentamicin, Tobramycin, Polymixin B + Neomycin
- Fluoroquinolones: Ciprofloxacin, Ofloxacin
-
Tx Otitis Externa
- Systemic abx (aminoglycs, fluoroquins)
- Acetic acid 2%
- Clotrimazole 1%
-
Etiology of Cerumin Impaction
- Narrow/misshaped ear canal
- Excessive hair growth
- Hearing aids/ Ear plugs
- Elderly
- Overactive ceruminous glands
-
Tx Cerumin Impaction
- Carbamide peroxide 6.5%: FDA approved softening agent for >12yo
- Mechanism: release of O2 from peroxide + urea, tissue debridement, cerumin breakdown
- Dosing: BID 4days
Lubricants/emolients: docusate Na, glycerine, olive oil, 1 - 1 H2O + peroxide
-
Prevention of Cerumin Impaction
- Use warm washcloth, not Qtip
- Only clean whats visible
-
Treatment of Water-clogged Ears
- Non-pharm:
- Tilting ear down, pulling ear down
- Blow dryer
- Pharm drying agents:
- Isopropyl alcohol: may be mixed w/ glycerin (emolient) or boric acid (incr acidity + weak germacide)
- Acetic acid: bacteriacidal/antifungal, <pH
- Boric acid: <pH, weak germicide
- NO ear drying agents with:
- Ruptured eardrum
- Ear tubes
-
Do NOT self treat ears if:
- S/s infection
- Ear discharge w/pain
- Bleeding or s/s trauma
- Ruptured tympanic membrane
- Ear surgery <6 wks
- Tubes
- <12yo
-
Ear Drops
- Body temp
- Adult ear: pull back and up
- Child ear: pull back and down
- May need to hold position after drops administered
-
Drug of choice Otitis Media
Amoxicillin
-
Drug of choice Otitis Externa
Topical acidifying / antimicrobial agents
(Acetic acid + mycin or floaxin)
|
|
