Currently Amoxicillin remains the remedy of first choice for uncomplicated acute otitis media due to its safety, comparative effectiveness, pleasant taste, and low cost. In particular, amoxicillin is the most effective among available oral antimicrobials against both penicillin-insensitive strains and S. pneumoniae susceptible to it.
Increase doses From the traditional 40 to 80-100 mg/kg/day usually provides a good effect against strains — penicillin intermediates and some penicillin-resistant. The increased dose should be used especially in children under 2 years of age and those who have recently been treated with b-lactams or who are in a large pediatric population because, as noted earlier, in these children the prevalence of resistant S strains. pneumoniae are the highest.
Limitation of use amoxicillin is due to the fact that it can be inactivated by the b-lactamases of many strains that are nontypical of H. influenzae, and by most strains of M. catarrhalis. Fortunately, cases of acute otitis media caused by these pathogens often, but not always, resolve spontaneously. For children who are allergic to b-lactams or for whom taste or convenience of administration is important, azithromycin, which also has an excellent safety record, is a suitable first-line choice.
Resistance to Trimethoprim/sulfamethoxazole Many strains of H. influenzae, S. pneumoniae and the reported high rate of adverse outcome of acute otitis media in children initially treated with this drug suggest its unacceptability as a first-line treatment.
Often the duration of the treatment of acute otitis media is 10 days with an apparent extrapolation of the optimal duration of treatment of streptococcal pharyngitis with penicillin. However, 10 days may be excessive for some children and insufficient for others. Studies comparing a shorter treatment period to a longer treatment period suggest that a short course is often inadequate for children under 6 years of age, especially under 2 years of age.
Thus, in most cases treatment, which ensures concentration of antimicrobial agents in the tissues, for at least 10 days seems appropriate. A short course, 3-5 days, may be appropriate for older children in relatively mild cases who are improving rapidly, while treatment longer than 10 days is often required for very young children, or for severe acute otitis media, or those with a history of otitis media problems.
Main purpose dynamic observation Is to assess treatment outcome and differentiate between inadequate response to treatment and early relapse. Accordingly, the required period of dynamic observation should be individualized. Observation for several days is appropriate for children in early infancy with severe illness or children of any age with persistent pain. Follow-up for 2 weeks. Necessary in infants or young children with frequent relapses.
Perhaps, eardrum (BP) has not returned to normal, but a significant improvement in her appearance should be evident. For children with a single episode of acute otitis media and rapid improvement in her appearance, observation within 1 month. after the initial examination is insufficient, and for older children, it may not be necessary at all.
In essence acute otitis media — Is an infectious, confined space disease, and its resolution depends on both elimination of the pathogen and restoration of middle ear ventilation.
Contributing factors unsatisfactory response to first-line treatment in addition to antimicrobial ineffectiveness include inadequate treatment regimens, current or mixed viral infection, persistent auditory tube dysfunction and insufficient aeration, reinfection from other foci, or immature or compromised patient immunity.
Despite this, switching to an alternative or second-line remedy will seem appropriate, If there is inadequate positive trend in the symptoms or condition of the middle ear, as reflected in the appearance of the eardrum (OA), or persistent purulent nasal discharge indicates that the antimicrobial agent used is ineffective. Second-line products may also be used for acute otitis media in a child already receiving antimicrobial prophylaxis, or in a child with immunodeficiency, or in a child with a history of severe symptoms and problems with otitis media.