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Guidelines

Guidelines (6)

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Acute Otitis Media (AAP)

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Diagnosis and Management of Acute Otitis Media

[Full Guideline from the AAP] [1-Page Summary by AAFP] [Full AAFP Review of AOM]

 

The diagnosis of acute otitis media requires one of the following findings:

  • moderate to severe bulging of the tympanic membrane
  • new ottorhea (that is not due to acute otitis externa)
  • mild bulging of the TM and recent (less than 48 hours) onset of ear pain or intense erythema of the TM.

Antibiotics should be given in one of the following settings

  • AOM (as above) with severe signs/symptoms (moderate/severe ear pain, ear pain for >48 hours, temperature >102.2 °F)
  • Bilateral AOM in children > 6 months but <2 years of age

If AOM is diagnosed but the patient does not meet the criteria above, choose one of the following options based on clinical judgement and discussion with patient:

  • prescribe antibiotics
  • observe with close follow-up (with a mechanism to prescribe antibiotics if the patient worsens or fails to improve within 2-3 days)

Choice of antibiotics:

  • Amoxicillin is first-line
  • Choose an alternative to amoxicillin if
    • child has recieved amoxicillin in past month
    • concurrent purulent conjunctivitis
    • allergy to penicillin
    • history of AOM unresponsive to amoxicillin
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Cholesterol ASCVD 2013

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The 2013 ASCVD Cholesterol Guidelines for dyslipidemia management by the ACC and AHA suggest a significant practice change.

Here is the complete guideline.

Here is a brief summary by AAFP. There is significant controversy surrounding this guidelines, and this page also links to editorials summarizing the discussion.

Basically, statins are indicated for the four following groups:

  1. Patients with any form of clinical ASCVD
  2. Patients with primary LDL-C levels of 190 mg per dL or greater
  3. Patients with diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
  4. Patients without diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%

Here's the ASCVD Risk Calculator:

For comparison's sake, here is a link to the old ATP III Cholesterol Guidelines.