OTITIS MEDIA

CASE SUMMARY

Seth, a 16-month-old boy with a diagnosis of acute otitis media

(AOM), is brought to his pediatrician because of ear pain, decreased

appetite, decreased playfulness, and difficulty sleeping. He has had

three episodes of AOM previously, the most recent episode having

occurred 2 weeks ago and treated with high-dose amoxicillin. He

was diagnosed with bronchiolitis approximately 1 month ago and

treated with symptomatic care with ibuprofen, fluids, and rest. His

mother reports Seth having a 1-day history of tugging at his right

ear and crying, and a 2-day history of decreased appetite, decreased

playfulness, and difficulty sleeping. His temperatures at home have

all been elevated (39.5°C), and he has been given ibuprofen 100 mg

Q 12 h × 2 doses. On physical examination, both right and left

tympanic membranes (TMs) are erythematous. Left ear appears

otherwise normal with normal landmarks visible. The right ear TM

is bulging with limited mobility; copious cerumen and purulent

fluid behind TM. The right ear landmarks are difficult to visualize

and view of the umbo is obstructed. In this patient, the diagnosis

of AOM is certain based on the acute onset of symptoms, signs of

middle ear effusion (MEE), and signs and symptoms of middle ear

inflammation, and is likely a treatment failure from the previous

episode. This patient is a candidate for antibacterial therapy based

on his age and severe illness (temperature above 39°C). Empiric antibiotic

selection should be based on the likely causative organisms,

antibiotic efficacy against resistant organisms, and patient factors

such as prior antibiotic tolerance and likely patient adherence to the

complete regimen. Additionally, antibiotic selection must take into

account the previous treatment for a similar diagnosis 2 weeks ago.

5334 CASE SUMMARY TABLEÂ

·         Symptoms;  List two pertinent signs and symptoms Â

Answer here  Â

·         Recommended  Drugs: List recommended drugs  as indicated for this diagnosis Â

Answer here Â

·         Drug Categories and Subcategories: Identify the category of each recommended drug Â

Answer here Â

·         Rationale Provide rationale, clinical guidelines, or evidence for the selected drug of choice Â

Answer here Â

·         Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate Â

Answer here Â

·         What Patients Must Understand:  Identify at least three appropriate teaching points for the patient and/or family Â

Answer here Â

 

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