Gordon H. Sun, MD, MS

April 29, 2014

AOM: What Do the Guidelines Say?

The AAP and the American Academy of Family Physicians (AAFP) produced an updated clinical practice guideline for the management of AOM in 2013. The guideline recommends either observation with close follow-up within 48-72 hours of AOM diagnosis or antibiotic therapy.

For drug-naive patients with no known penicillin allergy, amoxicillin or amoxicillin/clavulanate are both considered first-line options for AOM. In patients with penicillin allergy, certain cephalosporins that are thought unlikely to be associated with cross-reactivity may be considered; these include cefdinir, cefuroxime, cefpodoxime, and ceftriaxone. Azithromycin and ciprofloxacin are not considered first-line therapy for this indication.

Case Challenge 2: A Teen With Sinusitis

A 14-year-old girl presents to her pediatrician with a 12-day history of bilateral nasal congestion, nasal drainage, halitosis, and a persistent cough at all hours of the day. The rhinorrhea has become slightly more purulent in the past 1-2 days.

The patient denies fevers, visual changes, epistaxis, or headaches. She reports that she tried over-the-counter decongestants and "cold medicine," with no improvement in her symptoms. She has no history of surgery of the head and neck, and no known drug or environmental allergies.

On presentation, she appears nontoxic and is cooperative with examination. She is afebrile, with otherwise normal vital signs. Visual fields are normal, and she has full extraocular mobility.

Examination revealed edematous and inflamed nasal mucosa with enlarged inferior turbinates and scant mucopurulent rhinorrhea. Otoscopic examination is normal. The tonsils are not enlarged, and no purulence or postnasal drip is noted. The remainder of the physical examination is normal.


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