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Prof. Dr. Ergin FT
Ankara niversitesi Tp Fakltesi ocuk Enfeksiyon Hastalklar Bilim Dal
www.erginciftci.com
YEN KILAVUZLAR ELNDE OTT TANI VE TEDAVS
OTTKulan Hangi Blm?
KULAK
OTTS MEDABir Hastaln ki Yz
AKUT OTTS MEDA EFFZYONLU OTTS MEDA
AAP (2004) AAP (2013)
AKUT OTTS MEDA Klavuz
Hibir ey, grnd gibi kolay deildir.
AKUT OTTS MEDA AKUT OTTS MEDA
AKUT OTTS MEDAKlavuz
AKUT OTTS MEDAKlavuz
American Academy of Pediatrics. Diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AAP (2013)
AKUT OTTS MEDA AKUT OTTS MEDA
AKUT OTTS MEDABir ocukluk a Hastal
ocuklarda doktora bavurularn ve antibiyotik kullanmnn en nemli nedeni
ocuklarn %80den fazlas 3 yaa dek en az bir otit ata geirir.
En sk 6-24 aylar arasnda grlr.
Pik insidans: 9-15 ay
ERKNDEKNE GRE;
Daha horizontal
Daha ksa
Kkrdak miktar ve sertlii daha az
Nazofarenkse ald blgede adenoid
hipertrofisi
Adenoidlerin enfeksiyon kayna olmas
AKUT OTTS MEDA AKUT OTTS MEDA
AKUT OTTS MEDAocuklarda staki Tpnn zellikleri
ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).
AKUT OTTS MEDA AKUT OTTS MEDA
AKUT OTTS MEDATanm
Orta kulan akut balangl, efzyon ve
inflamasyonla seyreden enfeksiyonudur.
ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).
AAP (2004) AAP (2004)
AKUT OTTS MEDA Klavuz
Semptomlarn akut balamas (Kulak ars, ate...)
+
Orta kulakta inflamasyon
+
Orta kulak svs
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.
Ate
Huzursuzluk
Genel hastalk hali
shal, kusma
Kulan ekitirme
BEBEK
Ate
Kulak ars
Kulakta dolgunluk hissi
Genel hastalk hali
Ba dnmesi
itme bozukluu
OCUK
AKUT OTTS MEDAAkut Balayan Semptomlar
Spiro D, Arnold D. The concept and practice of a wait and see approach to acute otitis media. Curr Opin Pediatr 2008; 20: 7278
AAP (2004) AAP (2004)
AKUT OTTS MEDA Klavuz
Semptomlarn akut balamas (Kulak ars, ate...)
+
Orta kulakta inflamasyon
+
Orta kulak svs
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.
nce
Yar saydam
Arkasnda kemikler grlebilir
Ntral yerleimli
Hareketli
NORMAL KULAK ZARI NORMAL KULAK ZARI
AKUT OTTS MEDANormal Kulak Zar
NORMAL KULAK ZARI
AKUT OTTS MEDANormal Kulak Zar
NORMAL KULAK ZARI
AKUT OTTS MEDAOtoskopik Bulgular
Kulak zarnda kzarklk
Grimsi beyaz veya sar renk
Kabarklk (malleusun grlmesi engellenir)
Membran perforasyonu ve prlan aknt
Nadir olarak membranda bller
Bazen hava-sv veya hava-p seviyesi
Hareketliliin azalmas
AKUT OTTS MEDA AKUT OTTS MEDA
AKUT OTTS MEDA NORMAL
AKUT OTTS MEDAOtoskopik Bulgular
AKUT OTTS MEDA NORMAL
AKUT OTTS MEDAOtoskopik Bulgular
AKUT OTTS MEDA NORMAL
AKUT OTTS MEDAOtoskopik Bulgular
AKUT OTTS MEDA NORMAL
AKUT OTTS MEDAOtoskopik Bulgular
AAP (2004) AAP (2004)
AKUT OTTS MEDA Klavuz
Semptomlarn akut balamas (Kulak ars, ate...)
+
Orta kulakta inflamasyon
+
Orta kulak svs
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.
PNMOTK OTOSKOP PNMOTK OTOSKOP
AKUT OTTS MEDAPnmotik Otoskopik Muayene
TMPANOMETR
AKUT OTTS MEDA Timpanometri
Tip A
Tip B
Tip C
TMPANOMETR
AKUT OTTS MEDA NORMAL
AKUT OTTS MEDAOtoskopide Sv ve Bombeleme
iddetli enfeksiyon; Ate 39C
Orta-iddetli kulak ars
BEKLE-GR YAKLAIMININ UYGULANMASI
AKUT OTTS MEDATans Kesin Olmayan AOM
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.
AAP (2004) AAP (2013)
AKUT OTTS MEDA Klavuz
Otit tansn kesinletir!Kesin olmayan Otit tans koyabilirsin
AKUT OTTS MEDA
AKUT OTTS MEDATanm
Normal Hafif Orta Ar
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDA
AKUT OTTS MEDATanm
Normal Hafif Orta Ar
Kulak zarnda orta ya da ar bombeleme veya yeni gelien otore (akut otitis eksternaya bal olmayan)
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDA
AKUT OTTS MEDATanm
Normal Hafif Orta ArKulak zarnda hafif bombeleme
veYeni balayan (< 48 saat) kulak ars (kk bebeklerde kulan tutma, ekme, ovuturma)veyaKulak zarnda youn eritem
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDA
AKUT OTTS MEDATanm
Normal Hafif Orta Ar
Orta kulakta sv olmayan hastalara AOM tans konulmamaldr.
Pnmotik otoskopi ve/veya timpanometri ile gsterilmi orta kulak svs
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDAAr Tedavisi
AKUT OTTS MEDA
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
NorfloksasinSiprofloksasinEnoksasinFleroksasinLomefloksasinOfloksasinLevofloksasinRufloksasin
SparfloksasinTosufloksasinGatifloksasin PazufloksasinGrepafloksasin
ALIILMI ETKENLER
S. pneumoniaeH. influenzaeM. catarrhalis
S. aureusE. coliKlebsiellaPseudomonas
SIK OLMAYAN ETKENLER
M. pneumoniaeC. trachomatisM. tuberculosisA. otitidis
PeptostreptokokFusobacteriumBacteroides
RSVRhinovirusnfluenzaParainfluenza AdenovirusEnteroviruslarCMVHSV
ANAEROBETKENLER
VRALETKENLER
AKUT OTTS MEDAEtkenler
ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).
ETKENLER
21
S. pneumoniae
H. influenzae
3
M. catarrhalis
AKUT OTTS MEDAEtkenler ve Diren Durumu
zdemir H, ifti E, Durmaz R et al. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of PCV7 to the national vaccine schedule. Eur J Pediatr 2014; 173:313320.
DREN DURUMU
ETKENLER
21
S. pneumoniae
H. influenzae
3
M. catarrhalis
AKUT OTTS MEDAEtkenler ve Diren Durumu
Gr D. Et al. Antibacterial Resistance Among Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalisfrom Kuwait and 5 centres in Turkey: Results from the Survey of Antibiotic Resistance (SOAR) 2007-2009.
The great majority of isolates of S.pneumoniae, H.influenzae and M.catarrhalis yet remain susceptible to amoxicillin/clavulanate in all centresstudied in Turkey.
DREN DURUMU
Hollanda, sve, ngilterede baaryla
uyguland bildirildi
Antibiyotik kullanm daha az
Antibiyotik direnci daha az
Mastoidit skl daha fazla
Giderek daha fazla benimsenmeye baland
ANTBYOTKSZ DZELME BEKLE-GR YAKLAIMI
AKUT OTTS MEDAAntibiyotik ver ve Bekle-gr Yaklamlar
ifti E. Akut otitis mediada tan ve tedavi yaklamlar.Reform Solunum Yolu Enfeksiyonlar Blteni, 9-16 (2008).
H. influenzae%52
M. catarrhalis%75
S. pneumoniae%11
DDETL ENFEKSYON; Ate 39C
Orta-iddetli kulak ars
BEKLE-GR YAKLAIMININ UYGULANMASI
AKUT OTTS MEDABekle-gr Yaklam
American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.Diagnosis and management of acute otitis media. Pediatrics 2004; 113:1451-65.
AKUT OTTS MEDATedavi Klavuzlar
AAP 2013
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
DDETL SEMPTOMLAR; Ate 39COrta-iddetli kulak ars48 saatten uzun sreli kulak arsToksik grnen ocukzlem yaplabileceinin kesin olmamas
BEKLE-GR YAKLAIMININ UYGULANMASI
AKUT OTTS MEDABekle-gr Yaklam
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDAHangi Antibiyotik?
YEN ANTBYOTK SINIFLARININ GELM
ifti E. Kinolonlar. 30. Pediatri Gnleri, stanbul, 14 Nisan 2008.
AKUT OTTS MEDATedavi
AMOKSSLN30 gn iinde amoksisilin almamPrlan konjunktivit yok
AMOKSSLN-KLAVULONAT30 gn iinde amoksisilin almPrlan konjunktivit varAmoksisilin yantsz AOM yks var
TEDAV
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDATedavi
TEDAV
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
AKUT OTTS MEDATedavi
TEDAV
American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964e999
TEDAV BAARISIZLII48-72 saat iinde
Dzelme olmamasDaha ktleme olmas