Otitis%20media%20-%20acute Treatment

Treatment

Pharmacotherapy

Symptomatic Therapy

Analgesics

Eg Paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) [eg Ibuprofen]
- Opioids may occasionally be indicated
Considered the mainstay of pain relief for acute otitis media (AOM)
Effective analgesia for mild-moderate pain

Antibiotic Therapy

There are no data regarding initially withholding antimicrobial therapy in adult patients w/ AOM
- Treatment prevents development of complications

Amoxicillin/High-dose Amoxicillin

Amoxicillin at sufficient doses is still considered the 1st-line agent for AOM
It is effective against most of the bacteria which cause AOM including susceptible & intermediate-resistant pneumococci
In areas where Penicillin-resistant pneumococci are common, high-dose Amoxicillin should be given

Amoxicillin/clavulanic Acid (High dose)

High doses of Amoxicillin combined w/ clavulanic acid are recommended for patients who fail standard Amoxicillin therapy or in those who present w/ severe illness
This combination will provide coverage for beta-lactamase-producing organisms (eg H influenzae & M catarrhalis along w/ Penicillin-resistant S pneumoniae)

Cephalosporins (2nd & 3rd Generation)

Cefdinir, Cefpodoxime, Cefprozil & Cefuroxime are the preferred agents because of their effectiveness against drug-resistant S pneumoniae, H influenzae & M catarrhalis
- These agents may be considered in patients w/ non-type 1 hypersensitivity reaction to Penicillin
Ceftriaxone [intravenous (IV)/intramuscular (IM)] may be considered in patients unable to take oral medications (eg vomiting)
- Also recommended x 3 days in patients who fail Amoxicillin/clavulanate
- Has superior efficacy to S pneumoniae compared w/ alternative oral antibiotics

Co-trimoxazole

Co-trimoxazole may be considered in patients w/ type 1 allergy to Penicillin
Use may be limited by local resistance patterns

Erythromycin/sulfafurazole

May be considered in patients w/ type 1 allergy to Penicillin
Depending on local resistance patterns, may be preferred over Co-trimoxazole

Advanced Macrolides

Eg Azithromycin or Clarithromycin
Active against the major pathogens that cause AOM
These agents have decreased activity against drug-resistant S pneumoniae

Clindamycin

May be considered in a patient who has persistent AOM after previous complete antibiotic therapy & in whom tympanocentesis is not possible for Gram stain & culture
Clindamycin may be effective against Penicillin-resistant pneumococcal infection not responding to other treatment
Clindamycin is not active against H influenzae or M catarrhalis & should not be used if these are suspected

Duration of Antibiotic Therapy

Optimal duration of antimicrobial therapy in AOM patients is uncertain
- May continue antibiotics x 5-7 days in mild-moderate illness & up to 10 days if severe

Current management of nosocomial and community-acquired pneumonia in ICU patients with novel antibiotics

Prof. Andrew Shorr, 27 Aug 2021

Nosocomial pneumonia serves as a paradigm for all severe infections, and appropriate antibiotic therapy is the key determinant of patient outcomes. Most data for the use of antibiotics are derived from studies in non-ICU patients and ignore critical care issues such as fluid resuscitation, mechanical ventilation, and changing renal function. Against the backdrop of increasing antimicrobial resistance and the COVID-19 pandemic, how do we optimize antibiotic administration in the ICU? Professor Andrew Shorr from Washington Hospital Center, Georgetown University, Washington DC, US discussed this burning issue at a Pfizer-sponsored satellite symposium, held during the Asia Pacific Intensive Care Symposium (APICS) 2021.

Multipathogen testing an essential part of Test-Target-Treat strategy for respiratory illnesses

Dr. Mohan Ravuru, Dr. Johnny Sinon, Assoc Prof. Nuntra Suwantarat, 16 Dec 2022

At a recent webinar, experts discussed the paradigm shift in respiratory illnesses and treatment practices as the COVID-19 pandemic transitions to an endemic phase. The late Dr Mohan Ravuru, Physician Researcher and former Asia Pacific Medical Director, Abbott, Dr Johnny Sinon, Senior Emergency Physician from Makati Medical Center, Philippines, and Associate Professor Nuntra Suwantarat, Infectious Disease Specialist, from Chulabhorn International College of Medicine, Thammasat University, Thailand, delivered informative presentations and engaged the audience through a stimulating panel discussion.

Among the topics covered were the ‘immunity debt’ phenomenon leading to potential epidemics, challenges in the differential diagnosis of COVID-19 and influenza, and the importance of point-of-care, multipathogen testing as a part of the Test-Target-Treat strategy in respiratory diseases.

Management of multidrug-resistant organisms in paediatric patients: Role of newer antimicrobial agents

Assoc Prof. Louis Grandjean, Adj Asst Prof. Natalie Tan, 01 Jul 2022

The management of multidrug-resistant (MDR) infections in children is complex, with limited studies and a relative lack of approved new antibiotics with paediatric indications.

At a recent Meet-the-Expert session, Dr Louis Grandjean, Consultant in Paediatric Infectious Diseases at Great Ormond Street Hospital and Associate Professor at University College, London, UK, addressed the growing threat of MDR infections in children and discussed treatment strategies and options for management. He focused on ceftazidime-avibactam (CAZ-AVI, Zavicefta^®), whose approval in Singapore was recently expanded to include paediatric patients aged 3 months and older.

Adj Asst Prof Natalie Tan, Senior Consultant at KK Women’s and Children’s Hospital, Singapore, chaired this webinar, which was organized by Pfizer under the auspices of the Singapore Paediatric Society and KK Women’s and Children’s Hospital.