A) Treat symptoms with analgesia
B) Give delayed RX to fill in 2 days if symptoms do not improve
• This patient meets the definition of acute otitis media because he is symptomatic (has ear pain) and has evidence of an effusion (bulging TM)
– Redness alone would not be diagnostic
• Given that he does not have severe symptoms (high fever, severe pain), or otorrhea, and is > 24 months old, an observation option with symptomatic treatment with analgesics +/- a “backup prescription” for antibiotics should the patient not improve is indicated
– Patients age 6-23 months with bilateral AOM, even without otorrhea or severe symptoms, should receive antibiotics
– Close follow-up in person or by telephone, without a “backup prescription,” is another option
• If the patient does require antibiotics, high dose amoxicillin is the first-line choice
– High dose augmentin is second-line therapy for when amoxicillin fails.
– Alternative therapy for penicillin-allergic patients or those not tolerating oral intake includes ceftriaxone IM for 1-3 days
• Reference: AAP Clinical Practice Guideline Pediatrics 2013;131(3):e964-99