How to Treat Otitis Media
In a report from the Drug-resistant S. pneumoniae Therapeutic Working Group it was recommended that oral amoxicillin should remain the first-line antimicrobial agent for treating pneumococcal otitis media (Dowell etal., 1999). However, in view of the increasing prevalence of penicillin resistance, a higher dose (an increase from 40-45 mg kg day to 80-90 mg kg day) was recommended for empiric treatment. For patients with defined treatment failure after 3 days, alternative regimens such as oral cefpodoxime, a single parenteral dose of ceftriaxone followed by oral cefpodoxime for 5 days or co-amoxiclav are recommended to cover infection caused either by a penicillin-resistant pneumococcus or by a P-lactamase-producing organism such as Moraxella catarrhalis or Haemophilus influenzae. The macrolides provide a viable alternative for the P-lactam-allergic patient. The same therapeutic considerations apply for sinusitis, which has a similar pathogenesis to otitis media.
Susan Horn et al. studied the relationship between formulary restrictive-ness and utilization of other health care services in six managed care organizations (MCOs) located in six states.28,29 The study included 13,000 patients over 1 year and used prospective data collection and multiple regression analysis. Formulary restrictiveness was associated with higher rates of emergency department visits and hospital admissions for all included diagnoses except otitis media, and was associated with higher drug cost, more prescriptions, and more office visits for some diagnoses. The range of effect was approximately twofold i.e., the most restrictive formulary tended to be associated with twice the utilization of the least restrictive formulary.
Observational studies in developing countries show a much higher risk of diarrhea in breast-fed infants exposed to complementary foods at 4-6 months than in those who were exclusively breast fed 1 . This difference was not observed in the two controlled trials in Honduras 6, 12 , presumably because the complementary foods were provided in sealed jars and leftovers were discarded after use, thus eliminating the risk of bacterial contamination. In industrialized countries, the study in Belarus demonstrated a significantly lower risk of gastrointestinal infection during the first year of life in the EBF group than in the MBF group (adjusted incidence density ratio 0.35 (0.13, 0.96)), even though the overall rate of gastrointestinal infection was very low 17 . Pooled results from studies in Australia 26 , Arizona 27 and Belarus 17 showed no significant differences between EBF and MBF groups in the risk of upper or lower respiratory infection or otitis media 4 . However, a recent analysis...
Only a handful of papers have been published describing the application SELDI TOF-MS technology to bacterial proteomics. A study by Barzaghi and colleagues (2004) was undertaken to determine the effectiveness of SELDI-TOF-MS for profiling microorganisms as a complementary technique or as an alternative to 2D-PAGE. Preliminary experiments were performed with Steptococcus pneumoniae (the leading cause of bacterial pneumonia, otitis media, and bacterial meningitis) in order to develop a protocol for SELDI analysis. Optimized parameters were then used to generate expression profiles from a wide range of gram-positive and gram-negative bacteria.
Studies on the polysaccharide vaccine have produced variable results, but overall protective efficacy in preventing bacteraemic infection ranges from 50 to 70 (Mangtani, Cutts and Hall, 2003). The main drawbacks of this vaccine are its ineffectiveness at preventing nonbacteraemic pneumococcal pneumonia, otitis media and exacerbations of chronic bronchitis and inability to protect children below the age of 2 years and the immunocompromised. In addition, data from several Asian countries suggest that the 23 vaccine serotypes account for only 63 of infections, and serotype data from many parts of the world are scarce (Lee, Banks and Li, 1991). The PCV has been shown to protect against meningitis, pneumonia, bacteraemia and otitis media in children vaccinated at 2, 4, 6 and 15 months of age. Serotype-specific efficacy was 94 after the first dose of vaccine and 97 after the fourth (Black etal., 2000).
One to two of 1,000 newborns suffer from congenital or perinatally acquired hearing disorders. The prevalence of neonatal hearing disorders has been reported to be increased 10- to 50fold in infants at risk, which includes preterm infants. In addition to hearing impairment as a result of heredity, which is the cause of the largest percentage of hearing disorders, a number of in utero and neonatal complications (e.g., infections, immaturity, asphyxia, ototoxic medications, and hyperbilirubinemia) have been described to be risk factors for neonatal hearing disorders. Ventilated infants are at increased risk for otitis media. Significant hearing impairment, often requiring hearing aides, occurs in 1 to 5 percent of infants born at gestational ages of less than 25 or 26 weeks (Hintz et al., 2005 Vohr et al., 2005 Wood et al., 2000) (see Chapter 11).
Up to 20 of patients, usually those with a large thyroid remnant, given sufficient 131I to deliver about 500 Gy (50000 rads) develop thyroiditis 142 , which occurs less often when 1110 MBq (30mCi) of 131I is administered 143 . Within a week, painful swallowing, neck and ear pain, thyroid tenderness and swelling, and transient mild thyrotoxicosis may occur, which is usually transient, requiring no therapy.
Symptoms are literally signs or indicators of an illness or disease. They are also a cause of suffering for the individual with the disease. According to the traditional medical model, observing symptoms, or patterns of simultaneously occurring symptoms, leads to the diagnosis of the underlying disorder. An example is a young child who has the sniffles, is cranky, tugs at his or her ear, and has a fever. The doctor examines the middle and inner ear and sees that it is red. All of these are symptoms or indicators of the illness commonly known as an ear infection. The earache, while a symptom of an infection, is also causing suffering for the child. The treatment is usually to provide antibiotics to stop the infection, which also relieves the child's pain. the child's earache, these symptoms can become a preoccupying and consuming experience in the person's life. In the case of the earache, with treatment the situation is temporary and specific. In the case of the most serious mental...
Influenza is a highly infectious acute respiratory disease causing epidemics and pandemics throughout the world. While it is usually a self-limiting disease, it can be complicated by bronchitis and secondary bacterial pnuemonia, and in children by otitis media. Primary influenza virus pneumonia is rare but carries a high case fatality rate. Epidemics are generally associated with a large number of excess deaths among the elderly and among those with underlying chronic respiratory and cardiac diseases, renal or metabolic diseases and immunosuppression. Epidemics and pandemics occur at unpredictable intervals. The clinical picture is of abrupt onset of fever, malaise, headache, sore throat, myalgia, coryza and a dry cough lasting 2-5 days. The clinical features in children and in the elderly may differ in some respects and children may present with febrile convulsions, conjunctivitis, croup, otitis media, bronchitis and gastrointestinal symptoms. Diagnosis based on clinical presentation...
Active cabin pressurization can adversely affect sinusitis and otitis. Air travel is contraindicated in those with pneumothorax or pneumomediastinum, and should be delayed for several weeks following middle-ear or thoracic surgery (Gong, 1991). The reduction in atmospheric oxygen during flight, while well tolerated by healthy travelers, can lead to marked hypoxemia in travelers with cardiopulmonary compromise, although the clinical significance of this is not completely clear (Gong, 1992). Dillard et al. (1991) found that pulmonary symptoms, including dyspnea, edema, wheezing, chest pain, and cyanosis, worsened during flight in 8 of 44 travelers (18.2 ) with chronic obstructive lung disease. Assessment of the need for supplemental oxygen is therefore recommended in travelers with underlying cardiopulmonary disease.