Acute otitis media — RACGP Fellowship MCQ

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EasyPaediatrics and adolescentAcute otitis mediaRACGP Fellowship

A 7-year-old child presents with a two-day history of ear pain after coryzal symptoms. He is afebrile, systemically well, and has a mildly bulging tympanic membrane. There is no otorrhoea and no risk factors for complications. What is the most appropriate initial management?

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Correct answer: A — Analgesia with review if symptoms persist or worsen

In a child >2 years with mild, uncomplicated acute otitis media (AOM), current evidence-based guidelines advocate watchful waiting with analgesia as the initial management. RACGP guidance (2025) emphasises that the main treatment for middle ear infection is pain relief with paracetamol or ibuprofen. Most children (60–80%) experience resolution within 3 days without antibiotics, and 60–75% resolve spontaneously. Antibiotics are reserved for children with severe systemic symptoms, otorrhoea, high-risk age (<6 months), or failure to improve within 48–72 hours. Option B (immediate amoxicillin) contradicts current antibiotic stewardship and is not indicated for mild uncomplicated disease. Option D (myringotomy) is reserved for severe, complicated, or recurrent cases, not routine AOM. Option E (topical drops) does not reach the middle ear and is inappropriate for otitis media. Option C (prednisolone) has no evidence-based role in uncomplicated AOM. Analgesia with safety-netting review is the most appropriate initial approach.

Reference: Royal Australian College of General Practitioners (2025). Antibiotic use for acute otitis media in children. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/first-do-no-harm/gp-resources/antibiotic-use-for-acute-otitis-media-in-children