Recent, usually abrupt onset of signs and symptoms of middle ear inflammation and effusion

and

Presence of middle ear effusion that is indicated by any of the following: bulging of the tympanic membrane, limited or absent mobility of tympanic membrane, air fluid level behind the tympanic membrane, otorrhea

and

Signs or symptoms of middle ear inflammation as indicated by distinct erythema of the tympanic membrane

or

Distinct otalgia (discomfort clearly referable to the ear[s] that interferes with or precludes normal activity or sleep)

Otitis media with effusion

Younger than six months: antibiotics

Six months to two years: antibiotics if diagnosis certain; antibiotics if diagnosis uncertain and severe illness

Older than two years: antibiotics if diagnosis certain and severe illness

Always assess pain. If pain is present, treatment to reduce pain

Oral: ibuprofen or acetaminophen (may use acetaminophen with codeine for moderate-severe pain)

Topical: benzocaine

High-dosage amoxicillin (80 to 90 mg per kg per day)

If severe illness or additional coverage desired:high-dosage amoxicillin/clavulanate (Augmentin; 80 to 90 mg per kg per day of amoxicillin component)

Nonanaphylactic penicillin-allergic: cefdinir (Omnicef), cefpodoxime (Vantin), or cefuroxime (Ceftin)

Severe penicillin allergy: azithromycin (Zithromax) or clarithromycin (Biaxin)

Unable to tolerate oral antibiotic: ceftriaxone (Rocephin)

Diagnosis may include some or all of the following symptoms or signs: nasal drainage, nasal congestion, facial pressure or pain (especially when unilateral and focused in the region of a particular sinus), postnasal discharge, hyposmia, anosmia, fever, cough, fatigue, maxillary dental pain, ear pressure or fullness.

Nearly all cases of acute bacterial sinusitis resolve without antibiotics. Antibiotic use should be reserved for moderate symptoms not improving after 10 days or that worsen after five to seven days, and severe symptoms.

Usual antibiotic duration: 10 days

Failure to respond after 72 hours of antibiotics: reevaluate patient and switch to alternate antibiotic. Fiberoptic endoscopy or sinus aspiration for culture may be necessary.

Amoxicillin (80 to 90 mg per kg per day)

Amoxicillin/clavulanate (80 to 90 mg per kg per day of amoxicillin component), cefpodoxime, cefuroxime, cefdinir, ceftriaxone

For beta-lactam allergy: TMP-SMX (Bactrim, Septra), macrolides, clindamycin (Cleocin)

S. pyogenes (group A streptococcal infection). Symptoms and signs: sore throat, fever, headache, nausea, vomiting, abdominal pain, tonsillopharyngeal erythema, exudates, palatal petechiae, tender enlarged anterior cervical lymph nodes. Confirm diagnosis with throat culture or rapid antigen testing; negative rapid antigen test results should be confirmed with throat culture.

Respiratory viral causes, conjunctivitis, cough, rhinorrhea, diarrhea uncommon with group A streptococcal infection

Group A streptococcal infection: Treatment reserved for patients with positive rapid antigen test or throat culture

Penicillin V (Veetids), penicillin G benzathine (Bicillin LA)

Amoxicillin, oral cephalosporins, clindamycin, macrolides

Presents with prolonged unimproving cough (14 days); should clinically differentiate from pneumonia. Pertussis should be reported to public health authorities. C. pneumoniae and M. pneumoniae may occur in older children (unusual in those younger than five years).

Nonspecific cough illness

Treatment reserved for B. pertussis, C. pneumoniae, M. pneumoniae

Macrolides (tetracyclines for children older than eight years)

Sore throat, sneezing, mild cough, fever (generally less than 102ºF [39ºC], for less than three days), rhinorrhea, nasal congestion; self-limited (typically five to 14 days)

Adequate fluid intake; may advise rest, over-the-counter medications, humidifier

None