Otitis media

Otitis media

Treatment

The child is treated with antibiotics, preferably amoxicillin when not known for any allergy to amoxicillin. The amoxicillin is administered for ten days. High-dose amoxicillin is administered in two divided doses of up to 80mg-90mg per kg per day (Hoberman et al., 2016). The dosage depends on the weight of the child. The child is administered with Tylenol acetaminophen liquid 160mg/5mls per kg to relieve pain. Amoxicillin-clavulanate 90mg/kg per day can also be used to treat the patient.

Pathophysiology

The essential factor in otitis media is the diminished functioning of the Eustachian tube (ET) because it forms part of the middle ear. The bacteria interfere with the mucosa of the middle ear, which further causes negative intratympanic pressure that further results in direct extension of bacteria to the middle ear via the ET from the nasopharynx, which causes the disease (Norhayati, Ho & Azman, 2017). Also, the contents of the esophagus can be regurgitated to the nasopharynx and enter the Eustachian tube into the middle ear, therefore, creating a mechanical disturbance that causes inflammation of the middle ear. Among the children, the immature immune system, Eustachian tube alteration, and persistent respiratory tract infection increase the risk of developing otitis media.  The inflammatory process in the middle ear produces fluids that result in symptoms of  AOT, which include reddening of the tympanic membrane, fussiness, and fever.

Rationale and APRN role

Amoxicillin is used as the first-line treatment for otitis media in patients who are not allergic to the medication. The advantage of using amoxicillin is because it has a narrow microbiologic spectrum. APRNs should assess the patient for other clinical manifestations such as effusion and take history to determine the recurrence of otitis media. Further history taking and physical examination help in determining the most appropriate treatment. The APRN should educate the mother on the importance of avoiding pacifiers and bottle propping in the child to prevent the recurrence of the disease. The APRN should review the immunization of the child together and educate the mother on the importance of ensuring all the vaccine as per the immunization schedule are met because it helps in preventing diseases such as pneumonia and influenza that increases the risk of otitis media recurrence (Norhayati, Ho & Azman, 2017).

Indications and contraindications

Amoxicillin is indicated in patients who are suffering from bacterial infections, primarily those of the respiratory system, genitourinary infections, and pneumonia. In skin conditions such as cellulitis and acute otitis media, mostly among the children, are treated with amoxicillin.

Amoxicillin is contraindicated in patients who are hypersensitive to penicillin and patients with a severe allergy to beta-lactam medications (Schilder et al., 2016). It should be used with a lot of caution in patients with renal complications because it is eliminated via the kidney; therefore, the dose should be adjusted accordingly. Amoxicillin is also contraindicated in pregnant mothers and therefore, should be administered under the vigilant supervision of the mother.

Price for 3 drugs

Krogery pharmacy

Amoxicillin oral powder for reconstitution 125mg/5mls $11.41 for 80 milliliters

Tylenol acetaminophen liquid 160mg/5mls per kg $9.69 per 60mls

Amoxicillin-clavulanate 90mg/kg per day $ 12.32

Costco pharmacy

Amoxicillin powder for reconstitution 250mg/5ml $ 11.20 for 80 milliliters.

Tylenol acetaminophen liquid 160mg/5mls per kg $8.32 per 60mls

Amoxicillin-clavulanate 90mg/kg per day $ 11.93

Instructions on the drug

The patient should report any side effect related to the medication such as skin rashes, diarrhea, and vomiting to the doctor because it is a sign of hypersensitivity to the medication. The patient should comply with medication because poor medication adherence results in bacterial resistance to the medication, which increases the risk of managing other bacterial infections in the future. The patient is likely to have dark urine because of the changes in the liver, blood, and kidney function.