Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


EBM Approach to Otitis Media

Hunter Hoover, MD

  • Approach to diagnosing AOM:
    • Step 1: Is there fluid or not? No --> not AOM
    • Step 2: If yes, reposition the otoscope to see if is the TM bulging by visualizing the handle and the short process. This is the best predictor for bacterial infection with 90% sensitivity.
  • Treatment:
    • High dose amoxicillin first first line (80-90 mg/kg)
    • Augmentin can be first line for severe symptoms
  • Treatment in penicillin allergy:
    • Third gen cephalosporin has <1% true cross reactivity and generally safe
      • I.e. three shots of rocephin
    • If allergic to pen and ceph, then will have to use clindamycin and septra together.
  • Duration of treatment:
    • Studies were done for 3-5 days of treatment
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