How to treat a child with a red throat and ear?

Treatment of a Child with Red Throat and Ear

For a child with a red throat and ear, amoxicillin is the first-line treatment if acute otitis media (AOM) is diagnosed, but antibiotics should be withheld if the ear redness is isolated without bulging of the tympanic membrane. 1

Diagnostic Assessment

Ear Evaluation

1. Distinguish between types of ear conditions:

   • Acute Otitis Media (AOM): Requires moderate to severe bulging of tympanic membrane OR new onset of otorrhea not due to otitis externa 1
   • Mild AOM: Mild bulging of tympanic membrane AND recent onset of ear pain (< 48 hours) or intense erythema 1
   • Isolated redness: Redness of tympanic membrane with normal landmarks is NOT an indication for antibiotic therapy 1

2. Use proper diagnostic tools:

   • Pneumatic otoscopy is essential for accurate diagnosis 1
   • Ensure adequate visualization of tympanic membrane (may require cleaning ear canal) 1

Throat Evaluation

• Assess for signs of pharyngitis
• Consider streptococcal pharyngitis if there's intense throat redness, exudate, tender cervical lymph nodes, and absence of cough

Treatment Algorithm

1. For Ear Conditions:

If AOM is diagnosed:

• For children < 2 years old:

  • Antibiotic therapy is recommended regardless of severity 1
  • First-line: Amoxicillin 45 mg/kg/day divided twice daily 1, 2

• For children ≥ 2 years old:

  • With severe symptoms (high fever, intense earache): Antibiotic therapy 1
  • Without severe symptoms: Option for observation with symptomatic treatment for 48-72 hours 1

Special considerations:

• If child received amoxicillin in past 30 days OR has concurrent purulent conjunctivitis OR has recurrent AOM unresponsive to amoxicillin: Use antibiotic with β-lactamase coverage (amoxicillin-clavulanate, cefuroxime-axetil, or cefpodoxime-proxetil) 1

If only isolated redness of tympanic membrane:

• Do not prescribe antibiotics 1
• Reassess if symptoms persist for more than 3 days 1

If otitis media with effusion (OME):

• Antibiotics are not indicated 1
• Consider referral to ENT if prolonged course (>3 months) with hearing loss 1

2. For Red Throat:

• If streptococcal pharyngitis is suspected:
  • Obtain rapid antigen test or throat culture before starting antibiotics 3
  • If positive: Penicillin or amoxicillin is treatment of choice 4

Duration of Therapy

• For children < 2 years: Standard 10-day course 1
• For children 2-5 years with mild/moderate AOM: 7-day course 1
• For children ≥ 6 years with mild/moderate AOM: Standard 10-day course 1

Important Caveats

1. Avoid common pitfalls:

   • Don't prescribe antibiotics for isolated ear redness without other signs of AOM 1
   • Don't diagnose AOM without adequate visualization of tympanic membrane 1
   • Don't use antihistamines or decongestants for otitis media 1

2. Follow-up considerations:

   • Reassess if symptoms worsen or fail to respond within 48-72 hours 1
   • Be aware that middle ear effusion may persist for weeks after successful treatment (60-70% at 2 weeks, 40% at 1 month) 1

3. When to refer:

   • Difficulty visualizing tympanic membrane despite attempts to clean ear canal 1
   • Persistent symptoms despite appropriate therapy 1
   • Recurrent AOM (3+ episodes in 6 months or 4+ episodes in 12 months) 1

By following this evidence-based approach, you can ensure appropriate treatment while avoiding unnecessary antibiotic use, which is crucial for preventing antimicrobial resistance and optimizing patient outcomes.