Info

Medication or Drug Class

Dosage

Description

Rationale

Amoxicillin

40 mg/kg per 24 hr tid for 10 days

Antibacterial

Treats AOM because it is usually effective against the most commonly encountered bacteria

Antibacterials

Varies with drug

Many appropriate drugs, including clavulanate potassium (Augmentin), erythromycin, clarithro-mycin, azithromycin, sulfonamide, cefaclor, cefuroxime

Eradicate the bacterial infection

Other: Antimicrobial ototopical drops are indicated if the tympanic membrane is ruptured. Analgesic eardrops may help with the pain if there has been no perforation of the membrane. Acetaminophen is usually used to reduce fever. Ibuprofen may be used for moderate pain.

Independent

Explain to the parents that the symptoms should begin to resolve in 24 to 48 hours as the antibiotics take effect. If the acute signs increase in the first 24 hours despite antibiotics, the parents need to bring the child back for a return examination to rule out severe infections such as meningitis or suppurative complications. Make sure that the parents understand that the child needs to receive the entire course of therapy to prevent recurrent infections. Teach the parents that supportive therapy with relief of pain and fever will increase the child's comfort. Application of heat may provide pain relief.

Instruct the parents about bottle propping, feeding infants while they are recumbent, and passive smoke exposure, all of which are risk factors for developing AOM. Breastfeeding until at least 4 to 6 months has a protective effect against AOM. Encourage patients to attend follow-up appointments and to avoid requesting antibiotics unless it is absolutely necessary. If repeated infections occur and the child attends daycare, parents may want to consider another situation.

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