A 12-month-old child attends day care and is seen in a clinic for a second middle ear infection since age 8 months
The parent calls the nurse to report that after the third day of giving amoxicillin (Amoxil), the child continues to have a temperature of 39.5° C and is unable to sleep well because of pain. What will the nurse do?
a. Encourage the parent to discuss amoxicillin/clavulanate (Augmentin) with the child's provider.
b. Recommend that the parent consider removing the child from day care to reduce exposure to infection.
c. Schedule a clinic appointment for the child to clinic to receive ceftriaxone (Rocephin) IM.
d. Tell the parent the child will probably need surgery for tympanostomy tubes to reduce infections.
ANS: A
Resistant AOM is on the rise because of the emergence of resistant pathogens such as Haemophilus influenzae and Moraxella catarrhalis, which are resistant to beta-lactam antibiotics, and Streptococcus pneumoniae, which synthesizes altered penicillin-binding proteins. Resistance is treated with high-dose amoxicillin/clavulanate. The high dose of amoxicillin increases activity against amoxicillin-resistant S. pneumoniae, and the clavulanate component overcomes beta-lactam resistance of H. influenzae and M. catarrhalis. Removing a child from day care can help reduce the number of ear infections in infants and young children. This child has only experienced two episodes, and removing the child from day care may not be easy for this family, so this recommendation is not appropriate at this time. IM Rocephin is not recommended. Surgery for bilateral myringotomy tympanotomy tubes (BMTT) is used to reduce the number of episodes in children with recurrent AOM.
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