Ramírez-Marín JY, Merelo-Arias CA, Pérez-Dórame R, Strassburger-Lona K, Álvarez-Díaz CJ

Language: Spanish
References: 20
Page: 50-58
PDF size: 574.25 Kb.

ABSTRACT

Acute otitis media (AOM) is a highly prevalent disease worldwide, primarily in pediatric patients due to the inherent risk factors in their age group, anatomical and environmental conditions such as day care attendance, lack of breastfeeding and exposure to cigarette smoke, among others. The definitive diagnosis of AOM is clinical and is based on a sudden onset of the disease, signs and symptoms of otitis media and fluid in middle ear.
The most accurate method to evaluate the integrity of the patient’s tympanic membrane is a simple otoscopy, although its pneumatic variant is the most effective tool to determinate loss of tympanic membrane mobility. Several factors, including the patient's age, clinical stage, previous treatment and time evolution should be considered in order to choose the right treatment for AOM. The "wait-and-see prescription" in addition to systemic analgesics for 48-72 hours reduces unnecessary antibiotic prescription in non-severe cases. Amoxicillin 80-90 mg/kg is the first-line antibiotic in case of no improvement with the first strategy. A combination of amoxicillin and clavulanate is the next step when first antibiotic therapy fails. A cephalosporin like Ceftriaxone is indicated in treatment failure with amoxicillin in addition to other previous antimicrobial. The recommended treatment in patients allergic to penicillin is clarithromycin. The incidence of complications of AOM is low, these include: recurrent otitis media, conductive hearing loss, mastoiditis, facial nerve paralysis, meningitis and brain abscess. Monitoring 3-6 months after an episode without complications is recommended.

REFERENCES

1. Cenetec. Prevención, Diagnóstico y Tratamiento de la Otitis Media Aguda en la Edad Pediátrica: Catálogo Maestro de guías de práctica clínica (ed.) Guía de Práctica Clínica. México DF: Cenetec; 2011. p. 1-12.

2. Philip D. Yates, Shahram Anari. “Otitis Media”. En: Anil K. Lalwani Ed. Diagnóstico y Tratamiento en Otorrinolaringología. Cirugía de Cabeza y Cuello. McGraw-Hill Interamericana Editores. 2da ed. 2009; pp. 653-655.

3. Gómez-Barreto D, De los Monteros LE, López-Enríquez C, Suarez RR, De la Torre C. Streptococcus pneumoniae serotypes isolated from the middle ear of Mexican children diagnosed with acute otitis media. Salud Pública Mex. 2011;53(3):207-11.

4. Richard L Drake, Wayne Vogl, Adam WM Mitchell. Gray anatomía para estudiantes. Capítulo 8: Cabeza y cuello. España: Elsevier Inc. 1ra ed. 2005; pp. 854-857.

5. Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age. New England Journal of Medicine. 2011;364:105-15.

6. Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and Treatment of Otitis Media. Am Fam Physician. 2007; 76(11):1650-8.

7. Pérez-Hervada A, Jadraque Jiménez P. Exploración otorrinolaringológica en Atención Primaria. SEMERGEN. 2003;29(6):318-25.

8. Marchisio P, Bellussi L, Di Mauro G. Acute otitis media: From diagnosis to prevention Summary of the Italian guideline. International Journal of Pediatric Otorhinolaryngology. 2010;74(10):1209-16.

9. Campos Navarro LA, Barrón Soto M, Fajardo Dolci G. Otitis media aguda y crónica, una enfermedad frecuente y evitable. Rev FACMED. 2014;57(1):5-14.

10. Koopman L, Hoes AW, Glasziou PF, et al. Antibiotic Therapy to Prevent the Developed of Asymptomatic Middle Ear Effusion in Children with Acute Otitis Media: a metaanalysis of individual patient data. Arch Otolaryngol Head Neck Surg. 2008;134(2):128-32.

11. Little P, Gould C, Williamson I, et al. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ. 2001;322(7282):336-42.

12. Scottish Intercollegiate Guidelines Network (2003) Diagnosis and Management of Childhood Otitis Media in Primary Care. A National Clinical Guideline. Scottish Intercollegiate Guidelines Network. Disponible en: http://www. sign.ac.uk/pdf/sign66.pdf

13. Vidal Vademecum Spain [portal en internet]. Amoxicilina. Disponible en: http://www.vademecum.es/principiosactivos- amoxicilina-j01ca04

14. Vidal Vademecum Spain [portal en internet]. Disponible en: http://www.vademecum.es/principios-activos-amoxicilina + clavulanico acido-j01cr02 p1

15. Vidal Vademecum Spain [portal en internet]. Ceftriaxona. Disponible en: http://www.vademecum.es/principiosactivos- ceftriaxona-j01dd04

16. Vidal Vademecum Spain [portal en internet]. Paracetamol. Disponible en: http://www.vademecum.es/principiosactivos- paracetamol-n02be01

17. Vidal Vademecum Spain [portal en internet]. Ibuprofeno. Disponible en: http://www.vademecum.es/principiosactivos- ibuprofeno-m01ae01

18. Vidal Vademecum Spain [portal en internet]. Claritromicina. Disponible en: http://www.vademecum.es/principiosactivos- claritromicina-j01fa09

19. Vidal Vademecum Spain [portal en internet]. Clindamicina. Disponible en: http://www.vademecum.es/principiosactivos- clindamicina-j01ff01

20. Vidal Vademecum Spain [portal en internet]. Azitromicina. Disponible en: http://www.vademecum.es/principiosactivos- azitromicina-j01fa10.