What is the recommended treatment for acute otitis media in a 15-month-old female scheduled for myringotomy in 2 weeks?

Treatment of Acute Otitis Media in a 15-Month-Old Female Scheduled for Myringotomy

For a 15-month-old female with acute otitis media (AOM) who is scheduled for myringotomy in 2 weeks, amoxicillin at a dose of 80-90 mg/kg/day divided into two doses is the recommended first-line treatment. 1, 2

Initial Management Approach

• Pain management should be addressed immediately, regardless of antibiotic prescription, as pain relief is paramount in AOM treatment 2
• For a 15-month-old child with AOM, immediate antibiotic therapy is indicated rather than observation, as children under 2 years with AOM are at higher risk for complications 1
• The scheduled myringotomy in 2 weeks does not change the need for immediate antibiotic treatment of the acute infection 1

Antibiotic Selection

• Amoxicillin (80-90 mg/kg/day divided into two doses for 5-10 days) is the first-line treatment for AOM in this age group when the child has not received amoxicillin in the past 30 days, does not have concurrent purulent conjunctivitis, and is not allergic to penicillin 1, 2
• If the child has received amoxicillin in the past 30 days, has concurrent purulent conjunctivitis, or has a history of recurrent AOM unresponsive to amoxicillin, an antibiotic with additional β-lactamase coverage (such as amoxicillin-clavulanate) should be prescribed 1
• For penicillin allergy, alternative options include cefdinir, cefpodoxime, or cefuroxime 2

Follow-up and Monitoring

• Reassess the patient if symptoms worsen or fail to respond to initial antibiotic treatment within 48-72 hours 1
• If symptoms persist despite appropriate antibiotic therapy, consider changing to a second-line antibiotic with broader coverage 1
• Persistent middle ear effusion (MEE) is common after AOM treatment (60-70% at 2 weeks, 40% at 1 month) and does not necessarily indicate treatment failure if symptoms have resolved 1

Special Considerations for Upcoming Myringotomy

• The presence of AOM does not contraindicate the scheduled myringotomy procedure, but the ear should be monitored to ensure the acute infection resolves before the procedure 1
• Inform the otolaryngologist about the current AOM episode and treatment 1
• The myringotomy with tube insertion will help prevent recurrent AOM episodes and treat any persistent middle ear effusion 1

Potential Complications and Pitfalls

• Failure to adequately treat AOM before myringotomy could potentially complicate the procedure or recovery 1
• Persistent symptoms despite appropriate antibiotic therapy may indicate resistant organisms or a combined bacterial and viral infection 1
• If otorrhea develops after initial treatment, cleaning the ear canal before administering drops is essential for effective treatment 1
• Avoid aminoglycoside-containing eardrops due to potential ototoxicity; only use drops specifically approved for use with tympanostomy tubes if needed 1

Prevention Strategies Until Myringotomy

• Reduce risk factors where possible, such as avoiding supine bottle feeding and reducing pacifier use 2
• Ensure adequate pain management throughout the treatment course 2