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Acute otitis media — DCH MCQ

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ModerateCommon childhood illnessesAcute otitis mediaDCH

A 3-year-old girl is assessed 24 hours after developing fever and left-sided ear pain following a coryzal illness. She is alert, drinking normally and has no significant comorbidity. Her left tympanic membrane is bulging and erythematous; the right tympanic membrane is normal. There is no otorrhoea, perforation or mastoid tenderness. What is the most appropriate initial management?

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Correct answer: C — Give regular oral analgesia and safety-net review if worsening or not improving

The correct answer is C. This otherwise well 3-year-old has uncomplicated unilateral acute otitis media without otorrhoea, mastoid signs or risk factors for complications. NICE recommends regular age- or weight-appropriate paracetamol or ibuprofen and either no antibiotic or a back-up prescription for children unlikely to benefit from antibiotics. Parents should seek review if symptoms worsen rapidly or significantly, do not begin improving within 3 days, or the child becomes systemically very unwell. Nursery exclusion and routine ENT review are unnecessary. If an oral antibiotic is indicated, amoxicillin is first line; co-amoxiclav is second choice after deterioration on first-line treatment. Topical antibiotic drops do not treat uncomplicated acute otitis media, although anaesthetic–analgesic drops may be considered when the tympanic membrane is intact and immediate oral antibiotics are not given.

Reference: NICE. Otitis media (acute): antimicrobial prescribing (NG91), sections 1.1 and 1.2. Published 2018; updated 11 March 2022. https://www.nice.org.uk/guidance/ng91/chapter/Recommendations