GP CCE Cases · child-and-youth-health
Toddler with earache and fever — CCE clinical encounter
CCE-style clinical encounter: a 20-month-old with fever and ear-pulling, a parent demanding antibiotics, and an otoscopy that decides everything. The candidate must examine properly, apply the immediate-antibiotic criteria, prescribe precisely, and safety-net for mastoiditis.
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Prompt
A 20-month-old boy is brought in by his mother for a second opinion after three days of coryza, now with fever to 39.2°C, one vomit overnight, and pulling at both ears. He attends daycare five days weekly. His cousin 'had grommets'. The mother wants antibiotics today; the previous clinic said wait it out. He is alert but irritable.
Objectives
- Perform a structured assessment: general state, hydration, otoscopy of both drums including pneumatic mobility. [1]
- Apply the immediate-antibiotic criteria to this child (under 2, bilateral disease if confirmed). [2]
- Prescribe precisely with dose and duration, and explain why duration matters here. [3]
- Negotiate with a parent who has already been refused antibiotics once — validate then decide on evidence. [1]
- Safety-net for mastoiditis and other complications with concrete instructions. [1]
References3ShowHide
- [1]Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children Cochrane Database Syst Rev, 2023.PMID 37965923
- [2]Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age N Engl J Med, 2011.PMID 21226576
- [3]Hoberman A, Paradise JL, Rockette HE, et al. Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children N Engl J Med, 2016.PMID 28002709