Diagnosis of acute otitis media in the febrile, screaming child may be difficult. Only 40% of children with red tympanic membranes have acute otitis media. When the diagnosis is uncertain, consider supportive treatment for 24 to 48 hours, and prescribe antibiotics only if symptoms persist.
- Only 40% of children with ‘red ears’ have acute otitis media. If a diagnosis of acute otitis media is doubtful consider 24 to 48 hours of conservative management.
- Amoxycillin remains the treatment of choice for patients with acute otitis media; if there are resistant organisms higher doses or treatment with amoxycillin/potassium clavulanate or cefaclor may be needed.
- Recurrent otitis media (that is, three to four episodes per year) with underlying persistent middle ear effusion warrants insertion of ventilation tubes.
- Referral for specialist care and management is warranted for the neonate and young infant with persistent disease, or when there are complications.