From the Guidelines
For a viral acute otitis media (AOM) note template in a 6-year-old, I recommend a structured approach focusing on symptomatic management rather than antibiotics. The note should document fever duration and severity, ear pain characteristics, presence of ear drainage, associated symptoms like rhinorrhea or cough, and examination findings including tympanic membrane appearance (redness, bulging, mobility) 1. Treatment should include acetaminophen (10-15 mg/kg every 4-6 hours, maximum 5 doses/day) or ibuprofen (10 mg/kg every 6-8 hours with food) for pain and fever, as these are effective for symptom management in viral AOM 1. Warm compresses to the affected ear can provide additional comfort. Parents should be advised that viral AOM typically resolves within 2-3 days without antibiotics.
The note should include return precautions, such as worsening pain, persistent fever >48-72 hours, new ear drainage, or concerning symptoms like lethargy or poor oral intake, to ensure timely intervention if the condition worsens or if bacterial infection is suspected 1. A follow-up plan should be documented, typically reassessment in 48-72 hours if symptoms persist or worsen, to monitor the progression of the disease and adjust the treatment plan as necessary. This approach aligns with evidence showing most pediatric AOM cases are viral and self-limiting, with antibiotics offering minimal benefit while increasing risk of side effects and antimicrobial resistance 1.
Key points to consider in the management of viral AOM in a 6-year-old include:
- Determining the likelihood of a bacterial infection, which is crucial for deciding on antibiotic use 1
- Weighing the benefits versus harms of antibiotics, considering the potential for side effects and antimicrobial resistance 1
- Implementing judicious prescribing strategies, such as watchful waiting for older patients or those with unilateral disease and without severe symptoms 1
- Using first-line therapy, such as amoxicillin with or without clavulanate, only when bacterial infection is likely 1.
From the Research
Note Template for Viral AOM in 6-Year-Old
Diagnosis and Symptoms
- Acute otitis media (AOM) is one of the most common childhood infectious diseases, with pain being the key symptom 2, 3
- Ear pain is central to children's and parents' experience of the illness, and analgesic treatment is regarded as the cornerstone of AOM management in children 2, 3
Treatment Options
- Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain relief in children with AOM 2, 3
- Amoxicillin is recommended as the first-line agent to treat uncomplicated AOM 4
- Ibuprofen may be more effective than placebo in relieving pain at 48 hours, with a risk ratio (RR) of 0.28 and a number needed to treat for an additional beneficial outcome (NNTB) of 6 2, 3
Management and Recommendations
- The current evidence on the effectiveness of paracetamol or NSAIDs, alone or combined, in children with AOM is limited 2, 3
- Further research is needed to provide insights into the role of ibuprofen as adjunct to paracetamol, and other analgesics such as anaesthetic eardrops, for children with AOM 2, 3
- Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad-spectrum agents and longer-than-recommended antibiotic durations 5
Additional Considerations
- Ibuprofen combined with antibiotics seemed to improve the outcome of experimental pneumococcal AOM, especially with the high dose 6
- The evidence is very uncertain about the effect of ibuprofen versus paracetamol on relieving short-term ear pain in children with AOM, as well as for the effectiveness of ibuprofen plus paracetamol versus paracetamol alone 2, 3