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<sup>18</sup> Consult specialist, consider tympanocentesis if series of abx fail, consider linezolid or levofloxacin.<br><br>
<sup>19</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].
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<sup>20</sup> Abx duration: <2 yo, or severe sx: 10 days; 2-5 yo mild-mod AOM: 7 days; ≥6 yo mild-mod: 5-7 days.
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<sup>21</sup> Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
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<sup>22</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]. Xylitol 3-5x/day may be effective for prevention of recurrent AOM in children >2 yo. Home remedies/homeopathy: no controlled studies.
<sup>19</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].
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<sup>20</sup> Abx duration: <2 yo, or severe sx: 10 days; 2-5 yo mild-mod AOM: 7 days; ≥6 yo mild-mod: 5-7 days.
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<sup>21</sup> Cross-reactivity w/ cephalosporins in nonsevere PCN allergy is 0.1%.
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<sup>22</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]. Xylitol 3-5x/day may be effective for prevention of recurrent AOM in children >2 yo. Home remedies/homeopathy: no controlled studies.
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For AOM pts worsening or failing to respond at 48-72h after tx:<sup>18,19</sup>