Patient Care and Monitoring of AOM

1. Assess the patient's signs and symptoms. Are they consistent with AOM?

2. Review diagnostic information to determine if acute infection is present. Are all three diagnostic criteria present? Was the proper method used for diagnosis (pneumatic otoscopy)?

3. Does the patient require antibiotic therapy, or is observation an appropriate option?

4. Obtain a complete medication history, including prescription drugs, nonprescrip-tion drugs, and natural product use, as well as allergies and adverse effects.

5. Determine what medication should be used for pain, if present.

6. If applicable, determine which antibiotic to use and the duration of therapy.

7. Develop a plan to assess effectiveness of the chosen therapy and course of action to take if the patient does not improve or worsens.

8. Provide patient education on:

• What to expect from prescribed medication, including potential adverse effects

• Avoidance of antihistamines and decongestants

• Signs of treatment failure

9. Stress the importance of adherence to therapy, including antibiotic resistance concerns.

10. Determine the need for influenza and pneumococcal vaccinations.

11. Educate the family regarding risk factors for otitis media.

Bacterial pathogens that cause sinusitis are similar to those that cause AOM. S. pneumoniae and H. influenzae are responsible for over half of the cases in all patients, with an additional 20% of cases caused by M. catarrhalis in children.23,25 Similar to AOM, an increased prevalence of H. influenzae has been reported in ABRS, and risk factors can predict the presence of drug-resistant pathogens.1,26 Other pathogens that cause sinusitis include S. pyogenes (up to 5%), anaerobic bacteria such as Bac-

teroides and Peptostreptococcus spp. (up to 9% of adults), and S. aureus (up to 10%

23,27

of adults). ' Chronic infections are commonly polymicrobial with a higher incidence of anaerobes, gramnegative bacilli, and fungi.

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