Otitis media in children — KFP-style written assessment

KFP 1 (10 marks)

A 20-month-old attends with fever to 39°C, vomiting once, and bilateral ear pain. Otoscopy shows moderate-to-marked bulging of both tympanic membranes with purulent effusion. He attends daycare four days weekly. ^[2]

1. State your antibiotic decision and the trial evidence that drives it. (4) ^[2]
2. Prescribe exactly: drug, dose, duration — including why that duration. (3) ^[2][3]
3. His mother asks whether five days would be enough 'to avoid resistance'. Answer with data. (3) ^[3]

Model answers

1. Immediate antibiotics. He meets two criteria: age under 2 with bilateral AOM, and severe features (fever above 39°C, vomiting). Hoberman's randomised trial in 6–23-month-olds showed amoxicillin-clavulanate reduced clinical failure from 23% to 4% at day 4–5 and from 51% to 16% at day 10–12 versus placebo. ^[2]
2. Amoxicillin-clavulanate at 90 mg/kg/day of the amoxicillin component, divided into two or three doses, for 10 days. The 10-day duration applies because he is under 2 with bilateral disease. ^[2][3]
3. Five days is not enough for him: the shortened-course trial found clinical failure in 34% with 5 days versus 16% with 10 days (difference 17 percentage points; 95% CI 9–25), with failure rates highest in daycare-exposed and bilateral infections — exactly his profile. Resistance concerns are real but are managed by correct first-line choice, not by under-treating this high-risk group. ^[3]