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Match the child with acute otitis media to appropriate therapy per AAP guidelines (all children well-appearing, non-toxic, no distress or indications of severe otalgia, symptomatic for 1 day, and have not had recent antibiotics in the last 30 days):
Child A) 5mo old with bilateral otitis media, afebrile
Child B) 18mo old with unilateral otitis media, fever to 38.5, penicillin-allergic
Child C) 27mo old with bilateral otitis media and bilateral purulent conjunctivitis and fever to 39.1
Child D) 37mo old with unilateral otitis media, fever to 39.5, penicillin-allergic
- Oral analgesic
- Amoxicillin 90 mg/kg/day divided BID
- Amoxicillin-Clavulanate 90 mg/kg/day divided BID
- Cefdinir 14 mg/kg/day
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April 15, 2020 at 1:11 pm
A) A2, B1, C3, D4
Child A is < 24mos old and has bilateral OM, an indication for antibiotic therapy, and amoxicillin 90 mg/kg/day divided BID is first-line. Child B is 48 hours, mod-severe otalgia), so observation option with analgesia only is warranted. Child C is > 24 mos old but has a severe symptom (fever > 39) and has otitis-conjunctivitis syndrome, which is worrisome for H. Flu, making Amoxicillin-Clavulanate the first choice antibiotic. Child D is > 24 mos old but has severe symptoms with the OM, so should be treated with antibiotics, and given the child’s penicillin allergy, cefdinir is the first choice.
Review here: http://pemsource.org/wp-content/uploads/2016/04/Otitis-Media.pdf