![]() For patients with recurrent or persistent acute otitis media, those taking prophylactic amoxicillin, those who have used antibiotics within the previous month, and those with concurrent purulent conjunctivitisįor patients with penicillin allergy. Safe, effective, and inexpensiveĩ0 mg of amoxicillin per kg per day 6.4 mg of clavulanate per kg per day, given orally in two divided doses aureus, Streptococcus pyogenes, Escherichia coli, or Klebsiella speciesīacteroides, Peptostreptococcus, or Propionibacterium speciesĨ0 to 90 mg per kg per day, given orally in two divided dosesįirst-line drug. Pseudomonas aeruginosa, Proteus mirabilis, S. Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis (in infants younger than six months), Mycobacterium tuberculosis (in developing countries), parasitic infestation (e.g., ascariasis), mycotic infections (e.g., candidiasis, aspergillosis, blastomycosis) Coinfection with bacteria present in more than 40 percent of children with viral-induced acute otitis media Respiratory syncytial virus, adenovirus, rhinovirus, or influenza virus may act in synergy with bacteria. In newborns, immunosuppressed patients, and patients with chronic suppurative otitis media More frequently associated with perforated tympanic membrane and mastoiditis Most common pathogens are serotypes 19F, 23F, 14, 6B, 6A, 19A, and 9VĬommon in older children. Increased incidence in children with allergic rhinitis, cleft palate, Down syndrome Increased risk of antibiotic treatment failure Increased incidence with cigarette smoke and air pollution, especially if parents smoke Native American, Alaskan, and Canadian Inuit children have increased incidence Underdeveloped physiologic and immunologic responses to infection in childrenīreastfeeding for at least three months is protective this effect may be associated with position maintained during breastfeeding, suckling movements, and protective factors in breast milkĬontact with multiple children and daycare providers facilitates spread of bacterial and viral pathogens Maximal incidence between six and 24 months of age eustachian tube shorter and less angled at this age. ![]() Hearing and language testing is recommended in children with suspected hearing loss or persistent effusion for at least three months, and in those with developmental problems. Patients who do not respond to treatment should be reassessed. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections. High-dosage amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy. Antibiotics are recommended in all children younger than six months, in those between six months and two years if the diagnosis is certain, and in children with severe infection. ![]() ![]() Observation is an acceptable option in healthy children with mild symptoms. Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis. Fever, otalgia, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common, but nonspecific symptoms. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Diagnostic criteria for acute otitis media include rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation.
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