ENT

Question 1

What are the indications for initiating antibiotics in a patient with acute otitis media in non-ATSI children?

Answer 1

• infants younger than 6 months
• children younger than 2 years with bilateral infection
• children who are systemically unwell (eg lethargic, pale, very irritable); fever alone is not an indication for antibiotic therapy
• children with otorrhoea
• children at high risk of complications (eg immunocompromised children)
• only one hearing ear
• cochlear implant
• consider in severe pain and if fever for more than 48 hours

Question 2

What criteria make ATSI children a high risk of complicated acute otitis media and therefore warranting antibiotics?

Answer 2

• living in a remote community
• <2 years old
• first episode of OM <6 months old
• persistent otitis media with effusion
• current bilateral AOM
• history of recurrent AOM
• current AOM with perforation
• current chronic suppurative otitis media
• Hx of chronic suppurative otitis media
• craniofacial abnormalities

Question 3

What are the two criteria for a high-risk episode (high chance of treatment failure) of acute otitis media in an ATSI child?

Answer 3

1. Children <2yo with fevers >38.5

2. Children <2yo with bilateral AOM