Key action statement 4b prescribe an antibiotic with

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Key Action Statement 4B: Prescribe an antibiotic with additional β-lactamase coverage for AOM if the child has received amoxicillin in the last 30 days, also has a purulent conjunctivitis, or has a history of recurrent AOM that does not respond appropriately to amoxicillin. Evidence Quality: Grade C. Strength: Recommendation (Lieberthal et al., 2013).
OTITIS MEDIA 5 Key Action Statement 4C: Reassess the child if the symptoms have worsened or did not respond to the antibiotics within 48-72 hours. Determine if change in therapy is needed. Evidence Quality: Grade B. Strength: Recommendation (Lieberthal et al., 2013). Key Action Statement 5A: Do not prescribe antibiotics prophylactically to reduce the frequency of episodes of AOM in children with recurrent AOM. Evidence Quality: Grade B. Strength: Recommendation (Lieberthal et al., 2013). Key Action Statement 5B: Tympanostomy tubes may be needed for recurrent AOM (3 occurrences in 6 months OR 4 occurrences within the past 12 months with 1 episode occurring in the previous 90 days. Evidence Quality: Grade B. Strength: Option (Lieberthal et al., 2013). Key Action Statement 6A: Recommend the PCV13 vaccine to all children according to the CDC schedule, AAP, and AAFP. Evidence Quality: Grade B. Strength: Strong Recommendation (Lieberthal et al., 2013). Key Action Statement 6B: Offer the annual influenza vaccine to all children according to the CDC schedule, AAP, and AAFP. Evidence Quality: Grade B. Strength: Recommendation (Lieberthal et al., 2013). 2Key Action Statement 6C: Encourage breastfeeding-only for ≥6 months. Evidence Quality: Grade B. Strength: Recommendation (Lieberthal et al., 2013). Key Action Statement 6D: Recommend tobacco use and exposure cessation and avoidance. Evidence Quality: Grade C. Strength: Recommendation (Lieberthal et al., 2013). Specified AOM Treatment Recommendations For this specific child, a thorough investigation needed to be conducted to determine the presence and type of acute otitis media. According to Burns, Dunn, Brady, Starr, Blosser, and Garzon (2017) suggest that there are 4 types of acute otitis media: AOM, Bullous Myringitis, Persistent AOM, and Recurrent AOM. Since the child is relatively healthy, does not have a history of otitis media but is displaying characteristic signs and symptoms such as ear pain, fever, and irritability, it is safe to suspect an initial onset of Acute Otitis Media. To determine the diagnoses of an AOM, a physical evaluation is warranted. Confirmation of an AOM can be evidenced by the use of a pneumatic otoscopy, tympanometry, or acoustic reflectometry (Burns et al., 2017). Presence of a bulging TM, decreased translucency, decreased or absence of TM
OTITIS MEDIA 6 mobility, air-fluid present behind the TM, or otorrhea provide a positive finding for AOM. In addition, an erythematic TM or non-visualized landmarks can also indicate a positive finding. Only a physical and otoscopic examination are needed for an AOM diagnosis. Ferri (2019) also includes that a tympanocentesis may be conducted if the patient is highly toxic, not responding to treatment from bullous myringitis, or is immunocompromised such as children younger than two months of age. A CT or MRI may be considered if a serious condition is suspected such as meningitis, brain abscess or severe mastoiditis (Ferri, 2019). Labs are

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