Suspected cases of bacterial conjunctivitis are removed from school or day care settings for diagnosis and start of treatment. General preventive measures include handwashing, and avoidance of rubbing or touching the eyes and sharing towels.
Use of pacifiers beyond the age of two years is associated with a substantial increase in otitis media. Viral infections and other conditions that cause inflammation of the nasal mucosa play a role in some cases. Nasal allergies and exposure to air pollution and cigarette smoke are examples of nasal irritants. Administration of influenza vaccine to infants in day care facilities substantially decreases the incidence of otitis media during the "flu" season. Ampicillin or sulfasoxazole given continuously over the winter and spring are useful preventives in people who have three or more bouts of otitis media within a six-month period. Surgical removal of enlarged adenoids improves drainage from the eustachian tubes and can be helpful in preventing recurrences in certain patients. In those with chronically malfunctioning eustachian tubes, plastic ventilation tubes are sometimes installed in the eardrums so that pressure can equalize on both sides of the drum (see figure 23.7). In the United States, this is the most common operation performed on children, but its value in preventing acute otitis media and hearing loss has been questioned. The first pneumococcal conjugate vaccine was approved in February 2000 for preventing life-threatening S. pneumoniae disease in infants. With general use this vaccine can prevent 1 million cases of otitis media and decrease the use of ventilation tubes by 20%. There are no proven preventive measures for sinusitis.
Bacterial conjunctivitis is effectively treated with eyedrops or ointments containing an antibacterial medicine to which the infecting strain is sensitive. Antibacterial therapy with ampicillin is generally effective against otitis media; alternative medications are available for communities where antibiotic-resistant strains of H. influenzae and S. pneumoniae are common. In general, antibacterial treatment has been highly successful in preventing serious complications such as mastoiditis and meningitis. Decongestants and antihistamines generally are ineffective and can be harmful.
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