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After completing this case study, the reader should be able to:

  • Identify the signs and symptoms of acute otitis media (AOM).

  • Identify risk factors associated with an increased incidence of AOM.

  • Identify the pathogens most commonly causing AOM.

  • Recommend an effective and economical treatment regimen including specific agent(s), route of administration, and dose(s) of antibiotics and analgesic medications.

  • Recognize the role of delaying antibiotic therapy for AOM.

  • Educate parents about recommended drug therapy using appropriate nontechnical terminology.


Chief Complaint

Per patient’s mom: “I’ve had it up to my ears with his ear infections!”


Seth Jacobs is a 16-month-old boy who is brought to his pediatrician by his distraught mother on a Monday morning in early March. Mom describes a 2-day history of tugging at his right ear and crying, and a 2-day history of decreased appetite, decreased playfulness, and difficulty sleeping. Mom states that his temperature last night was elevated by electronic axial thermometer (39.5°C), so she gave him 5 mL of ibuprofen every 12 hours × 2 doses. When Seth is asked if anything hurts, he does not respond. Mom requests all recommendations be written as prescriptions (even ibuprofen) for day care administration. She also notes that it is tax season and she needs Seth to be able to return to day care immediately so she can return to work as an accountant.


  • Former full-term, NSVD, 4-kg healthy infant at birth, breastfed for 6 months.

  • Immunizations are up-to-date, including four doses of 13-valent pneumococcal conjugate vaccination (Prevnar-13).

  • First episode of AOM at age 4 months treated with amoxicillin without adverse effects. Recurrent AOM × 3 over the past year; most recent episode 2 weeks ago treated with high-dose amoxicillin for 10 days without adverse effects.

  • Seth was seen approximately 1 month ago for persistent nonproductive cough of 5-day duration. A diagnosis of acute bronchiolitis was made and symptoms improved with ibuprofen treatment, fluids, and rest.


Both parents in good health. Two siblings, 3 and 6 years old, in good health.


Seth lives at home with his parents and two sisters. Both parents are employed and work out of the house. Seth and his 3-year-old sister attend day care. His elder sister attends elementary school. There is a pet dog in the home. Seth uses a pacifier regularly throughout the day. There is no smoking in the house.


Ibuprofen suspension 100 mg/5 mL, 100 mg (5 mL) Q 12 H × 2 doses in the last 24 ...

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