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It is necessary to develop evidence-based clinical guidelines as recommendations to clinicians who offer primary care for management of children aged 6 – 12 years old with uncomplicated otitis media (Takata & Chan et al., 2001, p. 239-247). The first step in doing so will have…
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Protocol for Otitis Media in Children Aged 6 – 12 Years Old It is necessary to develop evidence-based clinical guidelines as recommendations to clinicians who offer primary care for management of children aged 6 – 12 years old with uncomplicated otitis media (Takata & Chan et al., 2001, p. 239-247). The first step in doing so will have to be appropriate diagnosis followed by initial treatment of the child as well as recommendations for curtailing recurrence of the condition. Otitis media is a prevalent infection for which prescription mostly entails antibacterial agents. With this in mind, diagnosis and management of the disease has a notable impact on overall antibacterial agents use, cost of providing care, as well as health of children. The affected age group being mostly children, the analysis is that OM generates indirect costs owing to lost time from school and work creating a significant social burden.
A good nurse protocol for otitis media in children aged six to twelve years old should clearly define OM; identify its natural history without antibacterial treatment, measure relative effectiveness of these antibacterial regimens in prevention of clinical failure (Forgie and Zhanel et al., 2009, p. 457). Otitis media is the presence of purulent fluid inside the middle ear, which is associated with symptoms and signs of systemic or acute local illness. It is most prevalent during winter months in children especially six to seven years old and below. Otitis media is commonly seen after a viral infection of the upper respiratory tract. It has been especially noted to result from dysfunction of the Eustachian tube preventing the effective drainage of middle ear fluid.
The clinician or nurse should be aware that the client has an antecedent event, either an allergy or infection that results in congestion and edema of the mucosa of the middle ear, Eustachian tube, as well as the nasopharynx. Flow of the middle ear secretions is impeded following the Eustachian tubes congestion. This often increases negative pressure further causing fluid to be pulled into the middle ear. Increase in middle ear secretions causes growth of microbial pathogens resulting in otitis media. Treatment protocol in diagnosis and prescription establishes common pathogens as Streptococcus pyrogenes, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, as well as viral infection. Recent studies show that in 6 – 12 year olds infections have increased because of organisms that produce beta-lactamase and bacterial resistance to drugs (Barnett and Klein, 2005, p. 509-517).
In cases where otitis media recurs, in children it could be because of physiological or anatomical abnormality of the Eustachian tube. The predisposing factors for developing OM include family history of the disease, congenital disorders such as trisomy 21 or cleft palate, active or passive smoking (Marcy, 2003, p. 673-674). Prevalence is high in males. In diagnosis, the clinician/nurse should define the subjective and objective symptoms. Subjective ones include vertigo or earache, simple irritability, difficulty hearing, fever, signs of infection of the upper respiratory. Objectively there are signs such as otorrhea or decreased hearing, optional fever, irritability, diarrhea, and vomiting especially in children. Arising complications include loss of hearing as well as the tympanic membrane’s (TM) perforation. Criteria for diagnosis should be based on documented rupture or bulging of TM in terms of objectivity.
The prescription part is most tricky when it comes to otitis media. The clinician should apply caution because eighty percent of cases have spontaneous resolution (Larynx, 2012, p. 1-8). First caution is to prescribe antibiotics in a sparing manner. This is because they only improve resolution by approximately fifteen percent only while at the same time increasing the risk of bacteria forming resistance. Withhold antibiotic treatment for 6 – 12 year olds if they are non-toxic, has reliable follow-up and low-grade fever, including well contained/controlled pain with ibuprofen/acetaminophen. Persistent effusion in the middle ear two to three months after OM therapy is normal and requires no further therapy if clinical symptoms are not present.
For this age group, recommended antibiotic regimens include initial Amoxicillin treatment for ten days twice daily (Lieberthal and Carroll et al., 2013). Children under forty kilograms in weight are to be given eighty to ninety milligrams per day PO while those above forty kilograms receive two hundred and fifty to five hundred milligrams a day PO. For children these are chewable. For children who are allergic to penicillin, initial treatment will use Azithromycin with dosage in regimens. The five-day regimen, 10 mg/kg, max 500mg/day PO first day, and 5 mg/kg, max 250 mg/day PO for day two to five. The three-day regimen will be, 10 mg/kg, max 500mg/day PO for the three days and a single dose regimen, 30mg/kg, max 1500mg PO once. This is available in syrup, 100mg/5ml, 200mg/5ml, or as a capsule of 250mg. Non-pharmacological regimens entail modifying risk factors in order to improve resolution odds. The recommendations include avoiding passive smoking, controlling inhalant and food allergies, treat sinusitis, as well as limiting use of pacifiers after the age of one year.

References
Barnett, E. D. and Klein, J. O. 2005. The problem of resistant bacteria for the management of otitis media. Pediatric Clinics of North America, 42 (3), 509-517.
Forgie, S., Zhanel, G. and Robinson, J. 2009. Management of otitis media. Pediatrics & child health, 14 (7), 457.
Gess, E., Manojlovich, M. and Warner, S. 2008. An evidence-based protocol for nurse retention. Journal of Nursing Administration, 38 (10), 441-447.
Larynx, A. N. 2012. Clinical practice guidelines for the diagnosis and management of otitis media (OM) in children. Auris Nasus Larynx, 39 1-8.
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D. and Others. 2013. The diagnosis and management of otitis media. Pediatrics, 131 (3), 964-999.
Marcy, S. M. 2003. Management of otitis media. The Pediatric infectious disease journal, 22 (7), 673-674.
Takata, G. S., Chan, L. S., Shekelle, P., Morton, S. C., Mason, W. and Marcy, S. M. 2001. Evidence assessment of management of otitis media: I. The role of antibiotics in treatment of uncomplicated otitis media. Pediatrics, 108 (2), 239-247. Read More
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