Page 63 - Learnwell EVS
P. 63
tis
– O toscopy: brig h t red tym panic m em brane (or yellow ish if rupture is im m inent) and
presence of pus, eith er externalised (d rainag e in ear canal if th e tym panic m em brane
is ruptured ) or internalised (opaque or bulg ing tym panic m em brane). T h e com bination
of th ese sig ns w ith ear pain or fev er confirm s th e d iag nosis of A O M .
Note:
T h e follow ing otoscopic find ing s are not sufficient to m ake th e d iag nosis of A O M :
• A red tym panic m em brane alone, w ith no ev id ence of bulg ing or perforation, is
sug g estiv e of v iral otitis in a context of upper respiratory tract infection, or m ay be
d ue to prolong ed crying in ch ild ren or h ig h fev er.
• T h e presence of air bubbles or fluid beh ind an intact tym panic m em brane, in th e
absence of sig ns and sym ptom s of acute infection, is sug g estiv e of otitis m ed ia w ith
effusion (O M E ).
– C om plications, particularly in h ig h -risk ch ild ren (m alnutrition, im m unod eficiency,
ear m alform ation) includ e ch ronic suppurativ e otitis m ed ia, and rarely, m astoid itis,
brain abscess or m ening itis.
Treatment
– In all cases:
• T reatm ent of pain and fev er: paracetam ol P O , pag e 2 6 .
• E ar irrig ation is contra-ind icated if th e tym panic m em brane is ruptured , or w h en
th e tym panic m em brane cannot be fully v isualised . E ar d rops are not ind icated .
– Ind ications for antibiotic th erapy:
• A ntibiotics are prescribed in ch ild ren less th an 2 years, ch ild ren w h ose assessm ent
sug g ests sev ere infection (v om iting , fev er > 3 9 °C , sev ere pain) and ch ild ren at risk
of unfav ourable outcom e (m alnutrition, im m unod eficiency, ear m alform ation).
• F or oth er ch ild ren:
1 ) I f th e ch ild can be re-exam ined w ith in 4 8 to 7 2 h ours: it is preferable to d elay
antibiotic prescription. Spontaneous resolution is probable and a sh ort
sym ptom atic treatm ent of fev er and pain m ay be sufficient. A ntibiotics are
prescribed if th ere is no im prov em ent or w orsening of sym ptom s after 4 8 to
7 2 h ours.
2 ) I f th e ch ild cannot be re-exam ined : antibiotics are prescribed .
• F or ch ild ren treated w ith antibiotics: ad v ise th e m oth er to bring th e ch ild back if
fev er and pain persist after 4 8 h ours.
– C h oice of antibiotic th erapy:
• A m oxicillin is th e first-line treatm ent:
amoxicillin P O :
C h ild ren: 8 0 to 1 0 0 m g / kg / d ay in 3 d iv id ed d oses for 5 d ays
A d ults: 1 5 0 0 m g / d ay in 3 d iv id ed d oses for 5 d ays
• A m oxicillin/ clav ulanic acid is used as second - line treatm ent, in th e case of
treatm ent failure. T reatm ent failure is d efined as persistence of fev er and / or ear
pain after 4 8 h ours of antibiotic treatm ent.
amoxicillin/clavulanic acid (co-amoxiclav) P O for 5 d ays
T h e d ose is expressed in am oxicillin:
C h ild ren < 4 0 kg : 4 5 to 5 0 m g / kg / d ay in 2 d iv id ed d oses (if using ratio 8 :1 or
7 :1 ) or in
3 d iv id ed d oses (if using ratio 4 :1 )
N ote: th e d ose of clav ulanic acid sh ould not exceed 1 2 .5 m g / kg / d ay or 3 7 5
m g / d ay.
58
– O toscopy: brig h t red tym panic m em brane (or yellow ish if rupture is im m inent) and
presence of pus, eith er externalised (d rainag e in ear canal if th e tym panic m em brane
is ruptured ) or internalised (opaque or bulg ing tym panic m em brane). T h e com bination
of th ese sig ns w ith ear pain or fev er confirm s th e d iag nosis of A O M .
Note:
T h e follow ing otoscopic find ing s are not sufficient to m ake th e d iag nosis of A O M :
• A red tym panic m em brane alone, w ith no ev id ence of bulg ing or perforation, is
sug g estiv e of v iral otitis in a context of upper respiratory tract infection, or m ay be
d ue to prolong ed crying in ch ild ren or h ig h fev er.
• T h e presence of air bubbles or fluid beh ind an intact tym panic m em brane, in th e
absence of sig ns and sym ptom s of acute infection, is sug g estiv e of otitis m ed ia w ith
effusion (O M E ).
– C om plications, particularly in h ig h -risk ch ild ren (m alnutrition, im m unod eficiency,
ear m alform ation) includ e ch ronic suppurativ e otitis m ed ia, and rarely, m astoid itis,
brain abscess or m ening itis.
Treatment
– In all cases:
• T reatm ent of pain and fev er: paracetam ol P O , pag e 2 6 .
• E ar irrig ation is contra-ind icated if th e tym panic m em brane is ruptured , or w h en
th e tym panic m em brane cannot be fully v isualised . E ar d rops are not ind icated .
– Ind ications for antibiotic th erapy:
• A ntibiotics are prescribed in ch ild ren less th an 2 years, ch ild ren w h ose assessm ent
sug g ests sev ere infection (v om iting , fev er > 3 9 °C , sev ere pain) and ch ild ren at risk
of unfav ourable outcom e (m alnutrition, im m unod eficiency, ear m alform ation).
• F or oth er ch ild ren:
1 ) I f th e ch ild can be re-exam ined w ith in 4 8 to 7 2 h ours: it is preferable to d elay
antibiotic prescription. Spontaneous resolution is probable and a sh ort
sym ptom atic treatm ent of fev er and pain m ay be sufficient. A ntibiotics are
prescribed if th ere is no im prov em ent or w orsening of sym ptom s after 4 8 to
7 2 h ours.
2 ) I f th e ch ild cannot be re-exam ined : antibiotics are prescribed .
• F or ch ild ren treated w ith antibiotics: ad v ise th e m oth er to bring th e ch ild back if
fev er and pain persist after 4 8 h ours.
– C h oice of antibiotic th erapy:
• A m oxicillin is th e first-line treatm ent:
amoxicillin P O :
C h ild ren: 8 0 to 1 0 0 m g / kg / d ay in 3 d iv id ed d oses for 5 d ays
A d ults: 1 5 0 0 m g / d ay in 3 d iv id ed d oses for 5 d ays
• A m oxicillin/ clav ulanic acid is used as second - line treatm ent, in th e case of
treatm ent failure. T reatm ent failure is d efined as persistence of fev er and / or ear
pain after 4 8 h ours of antibiotic treatm ent.
amoxicillin/clavulanic acid (co-amoxiclav) P O for 5 d ays
T h e d ose is expressed in am oxicillin:
C h ild ren < 4 0 kg : 4 5 to 5 0 m g / kg / d ay in 2 d iv id ed d oses (if using ratio 8 :1 or
7 :1 ) or in
3 d iv id ed d oses (if using ratio 4 :1 )
N ote: th e d ose of clav ulanic acid sh ould not exceed 1 2 .5 m g / kg / d ay or 3 7 5
m g / d ay.
58
