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acute otitis media
rapid onset of signs and sx of inf of middle ear
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effusion
accumulation of fluid in middle ear
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otorrhea
discharge from ear
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high prevalence of AOM
first 2 yrs
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AOM more common in which season?
winter
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envir factors of AOM
- daycare attendance
- parental smoking
- breastfeeding-protective
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organisms involved in AOM
- Strep pneu
- Hae inf(non-typeable)
- Moraxella catarrhalis
- various others: S aur, E coli, Pseu aeruginosa
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clinical presentation of AOM
- otalgia
- hearing loss
- fever
- -also can be irritable, lethargic, no appetite, paci
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signs of inflammation
- redness or opacity of typ mem
- absense of light reflection
- bulging tympanic membrane
- immobility of tymp mem
- otorrhea
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symptomatic tx of AOM
- APAP-10-15mg/kg/dose q 4-6 h
- Ibu 5-10 mg/kg/dose q 6-8 h
- topical:
- Aralgan-antipyrine/benzocaine solution, fill and mr 1-2 hrs prf p CONTRA in perforated tymp
- or neomycin/polymyxin B/HC otic susp3 gtts 3-4x/d
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abx appropriate under six mo?
- questionable diag: yes
- def diag: yes
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abx app 6 mo-2 yrs
- questionable: if sign ear pain and fever eq or greater than 39C
- def: yes
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abx app >2 yrs
- questionable: consider observation
- def: if sign ear pan and fever equal or great to 39, or 102
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complications of AOM
- hearing loss (assoc w scarring)
- mastoiditis
- meningitis
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when are ABx recommended if appropriate
after being tx w abx initially or have failed 48-72 hrs of observation or initial management w anbicaterial agenets
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dose of amox
80-90mg/kg/d
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dose of augmentin
90mg/kg per day amox and 6.4 mg/kg/d clav
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if failed trial w initial abx
aug or ceftriaxone 3 days
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fever and/or severe olagia
aug, if allergy-ceftriaxone
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no fever and/or severe otalgia
amox or allergy, non-type:ceftriaxone, cefpodoxime, type 1: azith or clarith
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