Penatalaksanaan Oma

PENATALAKSANAAN OTITIS MEDIA AKUT (OMA) Fadhlina Muharmi Harahap 0708112239

• Most people with acute otitis media get better without treatment. However, because it is hard to predict whose symptoms will not lessen, some doctors treat all people with antibiotics, such as Amoxicillin . Other doctors give antibiotics only if the illness is severe or if symptoms do not lessen after 72 hours. • Pain relief is important. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain. • Decongestants containing phenylephrine may help adults (but not children)

• Antihistamines are useful for people who have allergies but not for those with colds. • If a person has severe or persistent pain and fever, and the eardrum is bulging, a doctor may perform a myringotomy, in which an opening is made through the eardrum to allow fluid to drain from the middle ear. The opening, which does not affect hearing, usually heals without treatment. • People who have repeated bouts of otitis media may need to have drainage tubes (tympanostomy tubes) placed in their eardrums

Terapi • Tergantung stadium penyakit – Oklusi tuba Eustachius  Obat tetes hidung + Antibiotik. – Hiperemis (pre supurasi)  Antibiotik + Obat tetes hidung + Analgetik + Miringotomi. – Supurasi  Antibiotik + Miringotomi. – Perforasi  Antibiotik + Obat cuci telinga. – Resolusi  Antibiotik.

Oklusi tuba Eustachius • Untuk membuka kembali TE sehingga tekanan (-) di telinga tengah hilang. • Obat tetes hidung HCl Ephedrin 0,5 % anak < 12 tahun atau HCl Ephedrin 1 % dalam larutan fisiologis  anak > 12 tahun & dws. • Sumber infeksi lokal harus diobati. Antibiotik (gol penisilin atau eritromisin) diberikan bila penyebabnya kuman.

Hiperemis (pre supurasi) • Antibiotik + obat tetes hidung + analgetik (paracetamol atau ibu profen [! Iritasi saluran cerna]) • MT sudah terlihat hiperemis difus, sebaiknya dilakukan miringotomi. • Resistensi  kombinasi dengan asam klavulanat atau sefalosporin • Terapi awal  penisilin IM  konsentrasinya adekuat di dalam darah  tidak terjadi mastoiditis terselubung, ggn pendengaran sebagai gejala sisa & kekambuhan. • Antibiotik diberikan min selama 7 hari. • Anak  Ampicilin 4 x 50-100 mg/kgBB/hr, Amoxicilin atau Eritromisin @ 3 x 50 mg/kgBB/hr.

Supurasi • Antibiotik + rujuk miringotomi (MT masih utuh)  gejala cepat hilang & tidak terjadi ruptur.

Perforasi • Sekret banyak keluar. • Obat cuci telinga H2O2 3% selama 3-5 hari + antibiotik yang adekuat sampai 3 minggu. • Biasanya sekret akan hilang & perforasi akan menutup sendiri dalam 7-10 hari.

Resolusi

• MT berangsur normal kembali, sekret (-), & perforasi menutup. • Tidak  antibiotik dapat dilanjutkan sampai 3 minggu. • Tetap  mungkin telah terjadi mastoiditis.

Antibiotics Labeled for the Treatment of Acute Otitis Media Penicillins Amoxicillin Amoxicillin-clavulanate (Augmentin) Sulfa-based combinations Erythromycin-sulfisoxazole (Pediazole) Trimethoprim-sulfamethoxazole (Bactrim, Septra) Macrolide/azalide Azithromycin (Zithromax) Clarithromycin (Biaxin) Second-generation cephalosporins Cefaclor (Ceclor) Cefprozil (Cefzil) Cefuroxime axetil (Ceftin) Loracarbef (Lorabid) Third-generation cephalosporins Cefdinir (Omnicef) Cefixime (Suprax) Cefpodoxime proxetil (Vantin) Copyright © 2000 by the American Academy of Family Ceftibuten (Cedax)

www.aafp.org

Highes t

Ceftriaxone (Rocephin)

Highes t

Amoxicillin Amoxicillin-clavulanate (Augmentin) Cefdinir (Omnicef) Cefpodoxime proxetil (Vantin) Cefprozil (Cefzil) Cefuroxime axetil (Ceftin)

Cefixime (Suprax) Ceftibuten (Cedax) Ceftriaxone (Rocephin) Amoxicillin-clavulanate (Augmentin) Cefpodoxime proxetil (Vantin) Cefprozil (Cefzil) Cefuroxime axetil (Ceftin) Loracarbef (Lorabid)

Azithromycin (Zithromax) Clarithromycin (Biaxin) Loracarbef (Lorabid)

Azithromycin (Zithromax) Cefaclor (Ceclor) Clarithromycin (Biaxin) Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Cefaclor (Ceclor) Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Amoxicillin Cefixime (Suprax) Lowest

Ceftibuten (Cedax)

Lowest

Erythromycin

FIGUR E 1.

Comparative in vitro FIGUR Comparative in vitro activity of activity of antibiotics E 2. antibiotics against betaagainst Streptococcus lactamase­positive Haemophilus pneumoniae. (Drugs are influenzae. (Drugs are listed listed alphabetically in each alphabetically in each cluster.) cluster.) Copyright © 2000 by the American Academy of Family Physicians www.aafp.org

Criteria for Initial Antibacterial-Agent Treatment or Observation in Children With AOM Certain Diagnosis

Uncertain Diagnosis

<6 month

Antibacterial therapy

Antibacterial therapy

6 month to 2 years

Antibacterial therapy

2 years

Antibacterial therapy if severe illness; observation option* if nonsevere illness

Antibacterial therapy if severe illness; observation option* if nonsevere illness Observation option*

Age

This table was modified with permission from the New York State Department of Health and the New York Region Otitis Project Committee.32,33 Observation is an appropriate option only when follow-up can be ensured and antibacterial agents started if symptoms persist or worsen. Nonsevere illness is mild otalgia and fever <39°C in the past 24 hours. Severe illness is moderate to severe otalgia or fever ≥39°C. A certain diagnosis of AOM meets all 3 criteria: 1) rapid onset, 2) signs of MEE, and 3) signs and symptoms of middle-ear inflammation. *

American Academy of Pediatrics (AAP)

References •

MERCK. Otitis Media (Acute). The Merck Manuals. c1995-2009 [updated 2008 Feb ; cited 2009 Apr 08]. Available from : http://www.merck.com/mmhe/sec19/ch220/ch220e.html

•

Sosialisman & Helmi. Kelainan Telinga Luar dalam Buku Ajar Ilmu Kesehatan Telinga, Hidung, Tenggorok, Kepala & Leher. Ed. ke-5. dr. H. Efiaty Arsyad Soepardi, Sp.THT & Prof. dr. H. Nurbaiti Iskandar, Sp.THT (editor). Jakarta : Fakultas Kedokteran Universitas Indonesia. 2006.

•

Pichichero ME. Acute Otitis Media: Part II. Treatment in an Era of Increasing Antibiotic Resistance. c2000 [updated 2000 Apr 15; cited 2009 Apr 08]. Available from : http://www.aafp.org/afp/20000415/contents.html

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American Academy of Pediatrics. Diagnosis and Management of Acute Otitis Media. Clinical Practice Guidelines. c2004 [updated 2004 May 5 ; cited 2009 Apr 08]. Available from : http://www.aappolicy.aappublications.org/misc/terms.shtml