Recurrent Acute Otitis Media

When attacks of acute otitis media are frequent and close together (e.g., three or more episodes in 6 months, or four or more attacks in 12 months, with one being recent), prevention is desirable. The parents/caretakers should be advised to avoid placing the child in a day-care center, or if this is not feasible, a facility should be chosen that has the fewest number of children possible. Also, they should be counseled about the increased risk of recurrent acute otitis media associated with smoking in the household. Although not effective in infants, the administration of the currently available pneumococcal vaccine is also recommended for children above the age of 2 years; the influenza vaccine is also advocated and can be administered to infants.

There is no general agreement today on the other nonsur-gical and surgical methods of prevention. Amoxicillin, 20 mg/kg in one dose (given at bedtime), has proved effective.25 If the child is allergic to the penicillins, a daily dose of sul-fisoxazole 50 mg/kg may be substituted. This prophylactic regimen can be continued during the respiratory season. But today, with the growing evidence that long-term, low-dose antimicrobial prophylaxis is associated with the emergence of resistant Pneumococcus in infants and young children, a more desirable option would be myringotomy and tympanostomy tube placement, as this operation has been shown to be effective for prevention of otitis media.25,26 Table 78-6 lists the indications for tympanostomy tube placement. Adenoidectomy may also be an option for those who have had one or more tympa-nostomy tube insertions in the past.21

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