Otitis media is an inflammation of the middle ear commonly affecting infants and children, often following a viral upper respiratory tract infection. Risk factors include respiratory infections, lack of breastfeeding, genetic predisposition, and exposure to tobacco smoke. Treatment involves pain management with acetaminophen or NSAIDs and antibiotics such as amoxicillin for bacterial infections, with alternatives for cases of penicillin allergy or treatment failure.

1. OTITIS MEDIA - Therapeutics
Dr. S P Srinivas Nayak,
Assistant Professor, SUCP
Hyderabad, Telangana
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

2. OTITIS MEDIA
• It is an inflammation of the middle ear. The
diagnosis includes signs and symptoms of
infection of the middle ear, such as otalgia, fever,
and irritability, as well as the presence of fluid in
the middle ear.
• Most nonspecific upper respiratory tract
infections have a viral,not bacterial, etiology and
tend to resolve spontaneously. Otitis media is
most common in infants and children.
• H. influenzae and M. catarrhalis, S. pneumoniae.
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

3. Risk factors
• Winter season/outbreaks of respiratory influenza virus
• Attendance at day care centers
• Lack of breast-feeding in infants
• Early age of first diagnosis
• Nasopharyngeal colonization with middle ear pathogens
• Genetic predisposition
• Siblings in the home
• Lower socioeconomic status
• Exposure to tobacco smoke
• Use of a pacifier
• Male gender
• Immunodeficiency
• Allergy
• Urban population
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7. PATHOPHYSIOLOGY
• Acute bacterial otitis media usually follows a viral
upper respiratory tract infection that causes
eustachian tube dysfunction and mucosal swelling in
the middle ear.
• Bacteria that colonize the nasopharynx thus enter the
middle ear and are not cleared properly by the
mucociliary system. In the presence of effusion, the
bacteria proliferate and cause infection.
• Children tend to be more susceptible to otitis media
than adults because the anatomy of their eustachian
tube is shorter and more horizontal, facilitating
bacterial entry into the middle ear.
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

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9. CLINICAL PRESENTATIONS
• General
The acute onset of signs and symptoms has cold symptoms of
runny nose, nasal congestion, or cough
• Signs and symptoms
Pain that can be severe (more than 75% of patients), Children
may be irritable, tug on the involved ear, and have
difficulty sleeping, Fever is present in less than 25% of
patients , Examination shows a discolored (gray),
thickened, bulging eardrum
Draining middle ear fluid occurs (less than 3% of patients)
that usually reveals a bacterial etiology
• Laboratory tests
Gram stain, culture, and sensitivities of draining fluid or
aspirated fluid if tympanocentesis is performed
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

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11. Treatment
• Acetaminophen or a nonsteroidal
antiinflammatory drug (NSAID) such as
ibuprofen should be offered early to relieve
pain and malaise in acute otitis media
regardless of the use of antibiotics
First Line
• Amoxicillin high dose alone or combined with
clavulonic acid.
• 50–90 mg/kg/day divided twice daily
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

12. Pencillin allergy cases
• Cefdinir 14 mg /kg /day once or twice daily
• Cefuroxime 30 mg/kg / day divided twice daily
• Cefpodoxime 10 mg/kg / day once daily
• Cefprozil 30 mg /kg /day divided twice daily
• Azithromycin 10 mg/kg/day IM/IV for 3 days
day 1, then 5 mg /kg /day for days 2–5
• Clarithromycin 15 mg /kg /day divided twice
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

13. TREATMENT FAILURE CASES
• Amoxiclav if plane Amoxicillin is given
• Ceftriaxone 50 mg /kg /day IM/IV for 3 days
• Other Alternatives:
• Clindamycin 30–40 mg/kg /day in 3 divided
doses
• tympanocentesis
6/4/2021 Dr. S P NAYAK MED EASY LECTURES

14. Thank you
6/4/2021 Dr. S P NAYAK MED EASY LECTURES