URTI CPG Booklet_consensus (English - pdf - 762 Kb) - MSO-HNS

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Once the patient has shown clinical improvement, follow-up is based on the usualclinical course of AOM. Persistent middle-ear effussion after resolution of acutesymptoms is common and should not be viewed as a need for active therapy. Twoweeks after an episode of AOM, 60% to 70% of children have middle-ear effussion,decreasing to 40% at 1 month and 10% to 25% after 3 months 36, Level I .Please see Management Algorithm for summary.e. Management in adultCurrent best practice recommends amoxicillin for uncomplicated AOM; continuingor switching to an alternative antibiotic based on clinical response after 48 hoursof therapy; and selection of second line antibiotics as first line choices when thepatient has already been on an antibiotic within the previous month or is otitisprone. Preferred second-line agents frequently noted in various guidelines includeamoxicillin/clavulanate and cefuroxime 35, Level III .Recommendation• The diagnosis of AOM requires a history of the acute onset of symptoms and signsof middle-ear inflammation and effusion. (Grade A)• Analgesia is a critical part of the treatment of AOM in children. Acetaminophenand ibuprofen are first-line treatments for mild to moderate pain. (Grade B)• Amoxicillin at a dose of 80 to 90 mg/kg/day should be the first-line antibiotic usedfor AOM in children. (Grade A)• 10 days of antibiotic treatment should be used for children younger than 6 years.(Grade C)• Antibiotic courses of 5 to 7 days may be chosen for children older than 6 yearswith mild or moderate AOM. (Grade A)• For management of uncomplicated AOM in adults, amoxicillin is the current bestpractice and the preferred second-line agents are amoxicillin/clavulanateand cefuroxime. (Grade C)15
Recommended Antibacterial Agents for Patients Who Are Being Treated Initially With Antibacterial Agents orWho Have Failed 48 to 72 Hours of Observation or Have Failed Initial Management With Antibacterial Agents 28, Level I .Temperature≥39 º Cand/orSevere OtalgiaAt Diagnosis for Patients Being TreatedInitially With Antibacterial AgentsClinically Defined Treatment Failure at48–72 Hours After Initial ManagementWith Observation OptionClinically Defined Treatment Failure at48–72 Hours After Initial ManagementWith Antibacterial AgentsAlternative forPenicillin AllergyAlternative forPenicillin AllergyRecommended Recommended RecommendedAlternative forPenicillin AllergyNoAmoxicillin(80–90mg/kg perday in 3 divideddoses)* Cefuroxime(30mg/kg per dayin 2 divided doses);#Azithromycin(10mg/kg per dayon day 1 followedby 5mg/kg per dayfor 4 days as asingle daily dose);#Clarithromycin(15mg/kg per dayin 2 divided doses)Amoxicillin(80–90mg/kg perday in 3 divideddoses)*Cefuroxime(30mg/kg per dayin 2 divided doses);#Azithromycin(10mg/kg per dayon day 1 followedby 5mg/kg per dayfor 4 days as asingle daily dose);#Clarithromycin(15mg/kg per dayin 2 divided doses)Amoxicillin-clavulanate (90mg/kgper day ofamoxicillin with6.4mg/kg per dayof clavulanate in 2divided doses)* Ceftriaxone(50mg/kg, 3 days;#ClindamycinYesAmoxicillinclavulanate(90mg/kg per dayof amoxicillin with6.4mg/kg per dayof clavulanate in 2divided doses)Ceftriaxone(50mg/kg, 1 or 3days)Amoxicillinclavulanate(90mg/kg per dayof amoxicillin with6.4mg/kg per dayof clavulanate)Ceftriaxone(50mg/kg 1 or 3days)Ceftriaxone(50mg/kg 1 or 3days)Tympanocentesis,Clindamycin*Non-anaphylactic reaction #Severe penicillin allergy16
Page 2 and 3: This guideline is meant to be a gui
Page 4 and 5: The draft guideline was posted on t
Page 6 and 7: REVIEW COMMITTEESThe process of dev
Page 8 and 9: 1.0 RHINOSINUSITISKEY POINTS1. Accu
Page 10 and 11: 1.4 INVESTIGATIONS• When the diag
Page 12 and 13: Management AlgorithmInitial evaluat
Page 14 and 15: 2.2 CLINICAL FEATURES2.2.1 The etio
Page 16 and 17: Strep Score for Group a Beta-Hemoly
Page 18 and 19: Management AlgorithmStrepScore=3Sym
Page 20 and 21: Figure 7 - Normal tympanic membrane
Page 24 and 25: Management AlgorithmChild aged 2 mo
Page 26 and 27: 13. Scheid DC, Hamm RM. (2004) Acut
Page 28 and 29: 37. Schappert SM. Office visits for
Page 30 and 31: 23NOTES
Page 32: Supported by an educational grant f

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