A detailed discussion of allergic disease is presented separately 96

A detailed discussion of allergic disease is

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with extreme hypersensitivity to cats. A detailed discussion of allergic disease is presented separately. 96.Antibiotics with acute otitis media (Brandi Thompson)Antibiotics are prescribed in a stepwise fashion beginning with a first-line antibiotic. A lack of improvement in the patient's condition may require a change to a second- or third-line agent.Primary Options1.amoxicillin : children: 80-100 mg/kg/day orally given in divided doses every 12 hours for 10 days2.amoxicillin/clavulanate : children >3 months of age: 80-100 mg/kg/day orally given in divided doses every 12 hours for 10 days moreSecondary Options1.cefdinir : children >6 months of age: 14 mg/kg/day for 10 days2.cefuroxime axetil : children: 30 mg/kg/day orally given in divided doses every 12 hours for 10 days
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Tertiary Options 1. azithromycin : children ≥6 months of age: 10 mg/kg/day orally (immediate-release) on the first day, followed by 5 mg/kg/day for 4 days; or 10 mg/kg/day orally (immediate-release) for 3 days; or 30 mg/kg/day orally (immediate-release) as a single dose; or 60 mg/kg/day orally (extended-release) as a single dose 2. ceftriaxone : children: 50 mg/kg/day intramuscularly/intravenously for 3 days 97. Method to remove ear wax at various ages Symptoms of Earwax Buildup 1. Too much earwax can cause rubbing of the ear or poking in the canal. 2. A piece of earwax can become dry and hard in the ear canal. This creates a feeling that an object is in the ear. 3. Complete blockage (plugging) of the ear canal by wax causes more symptoms. These include decreased or muffled hearing. 4. A large piece of earwax may be seen inside the ear canal. Causes of Earwax Buildup 1. Cotton Swabs. Earwax buildup is usually from using cotton swabs. They push the wax back in and pack it down. 2. Fingers. A few children (perhaps 5%) normally produce more wax than others. It usually will come out if it's not pushed back by fingers. 3. Ear Plugs. Wearing ear plugs of any type can also push wax back. Age 6 Years and Older - Ear Canal Flushing with Water: Under age 6, use only if advised by your child's doctor. 1. Buy a soft rubber ear syringe or bulb from the pharmacy. No prescription is needed. 2. Have your child lean over the sink. Reason: To catch the water. 3. Use lukewarm water (body temperature). Reason: To prevent dizziness. 4. Gently squirt the water into the ear canal. Then tilt your child's head and let the water run out. You may need to do this several (3-4) times. 5. If the earwax does not seem to be coming out, tilt the head. Then, flush it with the head tilted. Have the ear with the wax in it facing downward. Gravity will help the water wash it out (the waterfall effect). 6. Endpoint: Flush until the water that comes out is clear of wax. Also, the ear canal should be open when you look in with a light. 7. Afterwards dry the ear thoroughly. You can do this by putting a drop of rubbing alcohol in the ear canal. Or you can set a hair dryer on low. Hold it a foot away from the ear for 10 seconds. Ear Drops - Use for 4 Days to Soften the Earwax: 1. If the earwax is hard, soften it before flushing the ear canal. Use ear drops to break up the earwax.
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