Child aged 15 months.
Seen for AOM 2 days ago, left ear draining pus, right ear intact, bulla noted.
Started on amoxicillin 90 mg/kg/day, plus ofloxacin ear drops left ear.
Now still with erythematous, bulging tympanic membrane on the right.
Pulling at right ear. Temperature 38.6 axillary.
Left ear culture from 2 days ago growing a multi-drug-resistant S. pneumoniae.
Nasopharyngeal culture from 2 days ago shows same S. pneumoniae plus ß – lactamase (+) H. influenzae and M. catarrhalis.
Questions for discussion with faculty
- How would you approach the treatment of this child now that you have identified the organisms?
- Would you consult a pediatric infectious disease specialist?