For pts meeting dx criteria,<sup>5,6</sup> otalgia tx if needed, plus:

By vgreene, 26 May, 2015
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<sup>5</sup> Dx: mod-severe TM bulge OR new otorrhea (not otitis externa) [B/R] OR mild TM bulge w/ either intense TM erythema or <48 h onset ear pain [C/R]. Do not dx AOM in those w/o middle ear effusion based on pneumatic otoscopy and/or tympanometry [B/R].<br><br>
<sup>6</sup> Definition of severe sx: mod-severe otalgia or otalgia >48 h or fever ≥39°C.
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<sup>7</sup> Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
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<sup>8</sup> May offer T-tubes for recurrent AOM: either 3 episodes/6 mo or 4 episodes/1 yr, ≥1 episode in preceding 6 mo [B/O]. Home remedies/homeopathy: no controlled studies.
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If no amox in 30 days, no hx amox-unresponsive recurrence, no purulent conjunctivitis: amoxicillin 80-90 mg/kg/day PO bid x10 days [B/R]
If amox in 30 days or hx amox-unresponsive recurrence or purulent conjunctivitis: amoxicillin/clavulanate 90/6.4 mg/kg/day PO bid x10 days [C/R]