“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #45

Be a better antibiotic steward when it comes to treating Acute Otitis Media in children!

I often see patients present to the urgent care for continued ear pain after being on antibiotics for 2 days for a supposed “ear infection.” When I look at the TM, it is completely normal. WOW! That antibiotic worked really fast…

A mildly erythematous tympanic membrane or fluid seen behind it does not warrant an antibiotic.

The AAP and AAFP recommend starting pediatric patients on antibiotics if they are <6 months old, toxic appearing, and have severe signs and symptoms (otorrhea, persistent pain, fever greater than 39C, bilateral OM).

Otherwise, they recommend an observation approach in healthy children >2 years old, non-severe illness, unilateral ear disease, if they have the ability to follow up in 48-72 hours, and the parents are in agreement.

If you believe the patient needs treatment, the first line treatment is high dose amoxicillin. If they have been on a beta-lactam antibiotic in the last 90 days, then prescribe Augmentin instead.

As always, use your best clinical judgement!

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