Prevention and treatment of meningitis and acute otitis media in children with cochlear implants.
OBJECTIVE
To provide recommendations for 1) prevention of acute otitis media and meningitis via immunization and 2) antimicrobial therapy of acute otitis media and meningitis in children with cochlear implants.


METHODS
Literature review and policy statement from the American Academy of Pediatrics.


CONCLUSIONS
1) Children who are candidates for cochlear implants or have received cochlear implants should receive all-age appropriate vaccinations, including indicated doses of 13-valent pneumococcal conjugate vaccine, Haemophilus influenzae type b conjugate vaccine, and influenza vaccine. A supplemental dose of 13-valent pneumococcal conjugate vaccine is indicated for children who have received indicated doses of 7-valent pneumococcal vaccine, but have not received 13-valent pneumococcal conjugate vaccine. In addition, children 24 months and older should receive a single dose of 23-valent pneumococcal polysaccharide vaccine. 2) Acute otitis media in children with cochlear implants should be treated with an antimicrobial. During the first 2 months after implant, initial treatment of acute otitis media with a parenteral antimicrobial, e.g., cetriaxone, is indicated. High-dose amoxicillin or amoxicillin-clavulanate is an appropriate antimicrobial choice for empiric treatment of acute otitis media occurring 2 or more months after implant. In cases of meningitis occurring during the first 2 months after implantation, broad spectrum empiric antimicrobial therapy, e.g., meropenem and vancomycin, should be initiated pending the results of CSF culture. Empiric antimicrobial therapy with ceftriaxone and vancomycin is appropriate for cases of meningitis occurring 2 or more months after implant.
Rubin
Lorry G
LG
Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA. lrubin@lij.edu
D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D019929:Cochlear Implantation / Q000009:adverse effects; D003054:Cochlear Implants / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D010033:Otitis Media / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D057766:Policy; D014611:Vaccination
D000890:Anti-Infective Agents; D000658:Amoxicillin