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At 9:00 AM on Tuesday, Jan. 8th, 2001 Mr. and Mrs. Otopainski show up at your clinic with their 18 month old boy. They mention that their son, Tommy, had a cold for about 3 days and except for a mild cough and runny nose he was fine until 1:00 AM last night. He woke up crying and he felt very hot to the touch. His temperature was 103oF and he was very fussy. After 2 hours of holding and carrying their son they gave him some Tylenol® and in about 30 min he settled down and got back to sleep again at 4:00 AM. At 8:00 AM he awoke again crying. The high fever (104oF) had returned and they noticed Tommy was tugging on his left ear. Tommy's parents are hoping this isn't something too serious because he has missed 3 days of daycare and the parents have used up all their sick days due to their son's previous illnesses (1 episode of pneumonia [1/30/00], 4 episodes of otitis media [5/10/00, 7/15/00, 12/20/00, 10/4/00]) over the past year.

Other than the Tylenol® he took last night he is not taking any medications. All his immunizations are up-to-date. Tommy is allergic to penicillin.

Physical Examination:
Vital signs: Temperature: 104o F, Heart rate: 140 beats/min, Height: 25 inches, Blood pressure: 120/80 mmHg, Respiratory rate: 30 breaths/min, Weight: 25 lbs

General Appearance Head Eyes Ears
Nose Throat Chest Heart

To find the answers to this case click this link: answers.

1. What is the most likely diagnosis of this patient's current problem?

2. What are the most common causes of this patient's problem?

3. What antibiotic would you prescribe for this child's current problem?

Take Care and Think Microbiologically!
Neal R. Chamberlain, Ph.D.

Right tympanic membrane

No ouch.

Left tympanic membrane

Big OUCH! Bulging tympanic membrane and erythema

1= otitis media; 2= Streptococcus pneumoniae, Haemophilus influenzae (usually nontypable), Moraxella catarrhalis; 3= since this patient is allergic to penicillin the usually first line antibiotic, amoxicillin, is not recommended therefore an alternative like azithromycin or clarithromycin could be used. To help with the pain an oral analgesic like acetaminophen or ibuprofen can be used. A topical analgesic, benzocaine, may also be helpful.

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