A 9-month-old baby girl is brought to urgent care by her mother who reports that for the last 2 days she has been crying a lot, especially when lying down or during feeding, and she’s been irritable and pulling at her right ear. She has a fever of 101.1˚F. On examination of her ears, the tympanic membrane in the right ear is erythematous, bulging, and opaque. Decreased mobility is noted on pneumatic otoscopy. The left ear appears normal. Examination of the throat, nose, and neck reveals no significant abnormalities, and her lungs are clear bilaterally. What is the most likely diagnosis and treatment for this patient?
- Acute otitis externa, ofloxacin drops
- Mastoiditis, begin antibiotics and refer to otolaryngology
- Acute otitis media, amoxicillin appropriate for her weight (30 mg/kg/day divided BID) for 10-day course and acetaminophen for fever and pain relief. Recommend the parent follow-up with the family pediatrician if the child does not improve in 48 to 72 hours.
- Acute otitis media, prescribe acetaminophen for fever and pain relief and prescribe a SNAP to fill if she doesn’t seem better in 2 to 4 days. Recommend the parent take the baby to her pediatrician for follow-up.
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Answer: C. You diagnose the baby with acute otitis media. Antibiotic therapy is recommended by the American Academy of Pediatrics in children aged <2 years who have severe signs and symptoms that include otalgia for >48 hours, a temperature >102˚F, purulent drainage, or TM concerns, such as rupture or reduced mobility. The antibiotic of choice for the initial management of uncomplicated AOM is high-dose amoxicillin (80-90 mg/kg/day divided BID, max 1 g/dose) for 10 days if the patient does not have a penicillin allergy, has not received amoxicillin in the past 30 days, and does not have a concurrent purulent conjunctivitis.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
