What are the discharge instructions for a mother regarding her child's diagnosis of otitis media (inflammation of the middle ear)?

From the Guidelines

Your child has been diagnosed with otitis media, which is an infection of the middle ear, and the most recent and highest quality study recommends giving your child the prescribed antibiotic, typically amoxicillin, at the exact dose and schedule provided by your doctor (usually 40-90 mg/kg/day divided into two doses for 5-10 days) 1. To manage your child's condition, consider the following:

• Complete the entire course of antibiotics even if symptoms improve.
• For pain relief, you can give acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours) as needed.
• Keep your child's ear dry; avoid swimming and use cotton balls coated with petroleum jelly during baths.
• Have your child rest with the affected ear facing up to help drainage.
• Watch for worsening symptoms such as increased pain, fever above 102°F, drainage from the ear, or symptoms not improving after 48-72 hours of antibiotics, and contact your doctor if these occur. Some key points to note:
• A follow-up appointment may be needed in 2-4 weeks to ensure the infection has cleared.
• To prevent future ear infections, avoid secondhand smoke exposure, practice good hand hygiene, keep vaccinations up to date, and consider breastfeeding if applicable as it provides protective antibodies. It's essential to follow the prescribed treatment plan and attend follow-up appointments to ensure the infection is fully cleared and to prevent potential complications, as supported by the American Academy of Pediatrics and American Academy of Family Physicians guidelines 1.

From the FDA Drug Label

Safety and efficacy using azithromycin 30 mg/kg given over 3 days Protocol 4 In a double-blind, controlled, randomized clinical study of acute otitis media in pediatric patients from 6 months to 12 years of age, azithromycin (10 mg/kg per day for 3 days) was compared to amoxicillin/clavulanate potassium (7:1) in divided doses q12h for 10 days For the 366 patients who were evaluated for clinical efficacy at the Day 12 visit, the clinical success rate (i.e., cure plus improvement) was 83% for azithromycin and 88% for the control agent. Protocol 5 A double blind, controlled, randomized trial was performed at nine clinical centers Pediatric patients from 6 months to 12 years of age were randomized 1:1 to treatment with either azithromycin (given at 30 mg/kg as a single dose on Day 1) or amoxicillin/clavulanate potassium (7:1), divided q12h for 10 days. Clinical response (Cure, Improvement, Failure) was evaluated at End of Therapy (Day 12 to 16) and Test of Cure (Day 28 to 32). For the 321 subjects who were evaluated at End of Treatment, the clinical success rate (cure plus improvement) was 87% for azithromycin, and 88% for the comparator Protocol 6 In a non-comparative clinical and microbiological trial, 248 patients from 6 months to 12 years of age with documented acute otitis media were dosed with a single oral dose of azithromycin (30 mg/kg on Day 1). For the 240 patients who were evaluable for clinical modified Intent-to-Treat (MITT) analysis, the clinical success rate (i.e., cure plus improvement) at Day 10 was 89% and for the 242 patients evaluable at Day 24 to 28, the clinical success rate (cure) was 85%.

The patient discharge instructions to the mother for otitis media should include:

• Dosage: Azithromycin 30 mg/kg given as a single dose or 10 mg/kg per day for 3 days.
• Monitoring: The mother should monitor the child for signs of improvement, such as reduced fever and ear pain, and report any adverse events, such as diarrhea, vomiting, or rash, to the healthcare provider.
• Follow-up: The mother should schedule a follow-up appointment with the healthcare provider to evaluate the child's response to treatment and to assess for any potential complications.
• Adverse events: The mother should be aware of the potential adverse events associated with azithromycin, such as gastrointestinal symptoms, and seek medical attention if the child experiences any severe or persistent side effects 2.

From the Research

Patient Discharge Instructions for Otitis Media

Overview of Otitis Media

Otitis media is one of the most common infectious diseases affecting infants and children, and it is a leading cause of office visits and antibiotic prescriptions for this population 3. The management of otitis media includes antimicrobial therapy and pain relief.

Antimicrobial Therapy

The first-line treatment for uncomplicated otitis media is amoxicillin 3, 4. For patients who fail to respond to amoxicillin, second-line therapy options include high-dose amoxicillin/clavulanate and ceftriaxone 3, 4. The choice of antibiotic should be based on factors such as in vitro activity, pharmacokinetics, adverse events, palatability, and cost 4.

Pain Relief

Pain is a key symptom of otitis media, and analgesic treatment is regarded as the cornerstone of management 5. Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain relief in children with otitis media. Studies have shown that paracetamol and ibuprofen may be more effective than placebo in relieving short-term ear pain in children with otitis media 5. However, the evidence is very uncertain for the effect of ibuprofen versus paracetamol on relieving short-term ear pain in children with otitis media.

Discharge Instructions for Mothers

• Give your child the prescribed antibiotic as directed by the doctor.
• Use paracetamol or ibuprofen to relieve pain and fever, as directed by the doctor.
• Monitor your child's temperature and report any fever above 102°F (39°C) to the doctor.
• Keep your child hydrated by encouraging them to drink plenty of fluids.
• Avoid giving your child over-the-counter cough and cold medications, as they may not be effective and can have side effects.
• Follow up with the doctor as scheduled to ensure that the infection is clearing up and to report any concerns or side effects.

Key Points to Remember

• Otitis media is a common infectious disease in children that requires prompt treatment.
• Antimicrobial therapy and pain relief are essential components of management.
• Amoxicillin is the first-line treatment for uncomplicated otitis media.
• Paracetamol and ibuprofen may be used to relieve pain and fever.
• Follow the doctor's instructions for medication use and follow-up care.