Diagnosis and treatment of otitis media.
Diagnostic criteria for acute otitis media include rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Fever, otalgia, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common, but nonspecific symptoms. Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis. Observation is an acceptable option in healthy children with mild symptoms. 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. High-dosage amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections. Patients who do not respond to treatment should be reassessed. 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.
Ramakrishnan
Kalyanakrishnan
K
University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA. kramakrishnan@ouhsc.edu
Sparks
Rhonda A
RA
Berryhill
Wayne E
WE
D000208:Acute Disease; D000465:Algorithms; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006192:Haemophilus Infections / Q000175:diagnosis / Q000188:drug therapy; D006193:Haemophilus influenzae; D034381:Hearing Loss / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D001936:Moraxella catarrhalis; D045828:Moraxellaceae Infections / Q000175:diagnosis / Q000188:drug therapy; D010033:Otitis Media / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000188:drug therapy; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000188:drug therapy; D038781:Otoscopy; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002981:Clindamycin; D000658:Amoxicillin