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Acute Otitis Media — MRCPCH AKP MCQ

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ModeratePediatricsAcute Otitis MediaMRCPCH AKP

A 3-year-old child weighing 15 kg presents with a 2-day history of unilateral ear pain and fever. Otoscopy shows a bulging, inflamed tympanic membrane without perforation or otorrhoea. The child is alert and hydrated, with no mastoid tenderness. There is no penicillin allergy, and no antibiotic has recently been taken. Following clinical assessment, a decision is made to prescribe an oral antibiotic. Which is the most appropriate first-choice regimen?

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Correct answer: A — Amoxicillin 250 mg three times daily for 5 to 7 days

The correct answer is A. When an antibiotic is judged appropriate for acute otitis media, NICE recommends amoxicillin as first choice. For a child aged 1 to 4 years, the recommended regimen is 250 mg orally three times daily for 5 to 7 days. Many otherwise well children can initially receive no antibiotic or a back-up prescription, but the stem explicitly states that a prescribing decision has been made. Clarithromycin is the alternative first choice for penicillin allergy or amoxicillin intolerance. Co-amoxiclav is reserved for symptoms that worsen despite at least 2 to 3 days of first-choice treatment. Cefuroxime and azithromycin are not NICE first-choice regimens for uncomplicated acute otitis media. The original high-dose, twice-daily amoxicillin regimen reflected US rather than UK guidance.

Reference: National Institute for Health and Care Excellence. Otitis media (acute): antimicrobial prescribing, NICE guideline NG91, recommendation 1.2.1 and table 1. Published 2018; updated 2022. https://www.nice.org.uk/guidance/ng91/chapter/Recommendations