What to do for a 7-year-old child with acute tonsillitis and a small amount of white discharge in the right (R) ear accompanied by ear pain?

From the Guidelines

For a 7-year-old child with acute tonsillitis and right ear discharge with pain, seek medical attention promptly as this suggests both a throat infection and possible otitis media (middle ear infection). While waiting for medical care, you can give weight-appropriate doses of acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) to reduce pain and fever, as recommended by general pediatric guidelines 1. Ensure the child stays well-hydrated with cool liquids and soft foods that won't irritate the throat. Don't clean the ear or insert anything into it, as this could worsen the condition.

The doctor will likely prescribe antibiotics such as amoxicillin (typically 40-50 mg/kg/day divided into two doses for 7-10 days) to treat both infections, as tonsillitis and ear infections are often caused by the same bacteria 1. The white discharge suggests pus from the infection, and proper antibiotic treatment is essential to prevent complications like hearing loss or spread of infection. Complete the full course of antibiotics even if symptoms improve quickly.

It's also important to note that:

• Tympanostomy tube insertion is the preferred initial procedure for surgical candidates with otitis media with effusion (OME), as it has been shown to reduce effusion prevalence and improve hearing levels 1.
• Adenoidectomy should not be performed unless a distinct indication exists, such as nasal obstruction or chronic adenoiditis 1.
• Tonsillectomy alone or myringotomy alone should not be used to treat OME, as they are either ineffective or of limited efficacy and carry additional risks 1.

Given the age of the child and the presence of both tonsillitis and possible otitis media, it is crucial to follow the clinical practice guideline for otitis media with effusion and seek medical attention for proper diagnosis and treatment 1.

From the FDA Drug Label

Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Table 1 ... Ear/Nose/Throat ... Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours

For a 7-year-old child with acute tonsillitis and a small amount of white discharge in the right ear accompanied by ear pain, the recommended treatment is:

• Amoxicillin dosage for Ear/Nose/Throat infections: 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections, or 875 mg every 12 hours or 500 mg every 8 hours for severe infections.
• The dosage for pediatric patients is 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for mild/moderate infections, or 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for severe infections.
• Treatment should be continued for at least 10 days to prevent the occurrence of acute rheumatic fever.
• It is essential to consult a healthcare professional to determine the appropriate dosage and treatment duration for the child's specific condition 2.

From the Research

Diagnosis and Treatment of Acute Tonsillitis

• The diagnosis of acute tonsillitis is clinical, but it can be challenging to distinguish between viral and bacterial infections 3.
• Rapid antigen testing has a low sensitivity in diagnosing bacterial tonsillitis, while swabs are highly sensitive but take a long time 4, 5.
• The treatment of acute tonsillitis depends on the cause, with viral tonsillitis usually being treated with supportive care and bacterial tonsillitis being treated with antibiotics such as penicillins 3, 6.

Antibiotic Treatment

• Penicillins remain the treatment of choice for Streptococcus pyogenes tonsillitis, and augmented aminopenicillins have gained utility in concert with the increasing incidence of beta-lactamase producing bacteria 3.
• A short course of antibiotics can be effective in clearing streptococci from the throat, but the duration of treatment should be on a selective basis 6.
• However, routine or immediate antibiotic therapy for acute exudative tonsillitis in children may not be necessary, as Group A streptococcus only contributes to a minimal portion of acute exudative tonsillitis 7.

Management of Ear Pain and Discharge

• There is no specific guidance on the management of ear pain and discharge in the context of acute tonsillitis in the provided studies.
• However, it is essential to note that ear pain and discharge can be symptoms of other conditions, such as otitis media, and should be evaluated and managed accordingly.

Considerations for Tonsillectomy

• Tonsillectomy is still one of the most frequent procedures during childhood, but the indications and standards for tonsillectomy have changed over time 4, 5.
• A tonsillectomy in children under 6 years should only be done if the child suffers from recurrent acute bacterially tonsillitis, and partial tonsillectomy should be the first line therapy in other cases 4, 5.