Microbiology
Infections
Question 81 of 180
A 3 year old child is brought into ED complaining of pain in his left ear ongoing now for about a week. He is irritable and feverish tugging at his left ear. Otoscopy reveals a tense bulging tympanic membrane. Which of the following antibiotics would be most appropriate to prescribe in this case:
Answer:
The patient has otitis media which is viral in more than half of cases. An antibiotic prescription should be offered to people who are systemically unwell, who are at high risk of serious complications because of significant comorbidities or whose symptoms have lasted for 4 days or more without improvement. The first line antibiotic is amoxicillin for 5 days (clarithromycin is an alternative if penicillin allergic).Acute Otitis Media
Microbiology / Infections
Last Updated: 21st April 2019
Acute otitis media is an inflammation in the middle ear associated with effusion and accompanied by an ear infection.
Infective Agents
- Viral (> 50% of cases)
- Respiratory syncytial virus (RSV)
- Rhinovirus
- Bacterial
- Haemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Streptococcus pyogenes
- Staphylococcus aureus
Clinical Features
- Pain in affected ear – pulling, tugging or rubbing of ear
- Fever
- Irritability, crying, poor feeding
- Red and bulging tympanic membrane
Complications
- Rupture of tympanic membrane with pus discharge
- Hearing loss
- Rarely mastoiditis, meningitis, intracranial abscess, sinus thrombosis, facial nerve paralysis
Diagnosis
Clinical or microscopy, culture and sensitivity of specimen
Treatment
- Pain relief
- Antibacterial therapy should be offered to children with acute otitis media who are systemically very unwell, have signs and symptoms of a more serious illness, or those who are at high-risk of serious complications due to pre-existing comorbidities. Antibacterial therapy should also be considered if otorrhoea (discharge following perforation of the eardrum) is present, or in children under 2 years of age with bilateral otitis media.
- When antibiotics are indicated:
- Amoxicillin first line (suggested duration of treatment 5 days)
- Consider co-amoxiclav if worsening symptoms despite 2 - 3 days of treatment
- If penicillin allergic, clarithromycin or erythromycin
Report A Problem
Is there something wrong with this question? Let us know and we’ll fix it as soon as possible.
Loading Form...
- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
