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Antibiotic Resistance in O.M

Doctors are men who prescribe medicines of which they know little; to cure diseases of which they know less; in human beings of whom they know nothing” Voltaire

* Case 1 A 9 month old infant has a chief complaint of fever and fussiness since last PM. She has had a URI for the last several days, but has otherwise been well. PMH is significant for OM at age 6 months and day care attendance. After examination, you diagnosis AOM and prescribe Amoxicillin. After 3 days, the patient returns with persistent fever to 101 and fussiness. On exam you note that the TM is still erythematous and bulging. What do you do next??

Antibiotic Resistance in O.M.
* Case 2: A 24 month old child comes into your office for a routine health maintenance visit. He has been well and has had no significant PMH. On examination you note a right TM that is dull and has decreased mobility. The child has not had any significant symptoms. What would you do next??

Antibiotic Resistance in O.M.
* Organisms in Otitis Media:
o Pneumococcus : 35% of cases
o Haemophilus Influenza: 30% of cases
o Moraxella Catarrhalis: 10% of cases
o Virus: 33% of cases
o Staph species
o Strep species
o Mycoplasma

What’s causing resistant bacteria??
* many more kids in daycare
* increased use of antibiotics, especially broad spectrum agents
* incomplete courses of therapy
* Inappropriate therapy (for OME)

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Tags: chief complaint, health maintenance, Moraxella catarrhalis, persistent fever, resistant bacteria, routine health

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