Acute Otitis Media Decision Tool
<-- 1. Age group?
<-- 2. Visit timing?
<-- 3. Penicillin allergy?
AAFP information on drug allergy - Reidl (2003) Am Fam Physician 68: 1781-91
<-- 4. Acute onset? (Acute onset: Recent, usually abrupt onset of signs and symptoms of middle-ear inflammation and effusion.)
American Academy of Pediatrics Slidebook of otoscope images - Middle ear effusion signs
<-- 5. Bulging of the tympanic membrane?
<-- 6. Limited or absent mobility of the tympanic membrane?
<-- 7. Otorrhea?
<-- 8. Air fluid level?
Middle ear inflammation signs.
<-- 9. Distinct erythema at tympanic membrane?
<-- 10. Significant otalgia? Symptom of middle ear inflammation: Distinct otalgia (discomfort clearly referable to the ears that interferes with or precludes normal activity or sleep).
<-- 11. Severity?
Middle ear effusion and middle ear inflammation are absent. interpretationscore=(Q1)+(Q2)+(Q3)+(Q4)+(Qeleven);score>10057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>10052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>10047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>10044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>10042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days (6-7 days if age 6+)':score>10037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>10027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10022?'certain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days (6-7 days if age 6+)':score>10017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>10012?'certain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10009?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or azithromycin 5 days or clarithromycin 10 days':score>10007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10004?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>10002?'certain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>9999?'uncertain diagnosis, nonsevere illness: 48-72 hour observation or amoxicillin 10 days (6-7 days if age 6+)':score>1057?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1054?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>1052?'certain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1049?'uncertain diagnosis, nonsevere illness: clindamycin 10 days or ceftriaxone 3 days':score>1047?'certain diagnosis, severe illness: ceftriaxone 3 days':score>1044?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>1042?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1039?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>1037?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1034?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1032?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1029?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1027?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1024?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1022?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>1019?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>1017?'certain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1014?'uncertain diagnosis, severe illness: ceftriaxone 3 days or clindamycin 10 days':score>1012?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>1009?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or azithromycin 5 days or clarithromycin 10 days':score>1007?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1004?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>1002?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>999?'uncertain diagnosis, nonsevere illness: observation 48-72 hours or amoxicillin 10 days':score>157?'certain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>154?'uncertain diagnosis, severe illness: tympanocentesis plus clindamycin 10 days':score>152?'certain diagnosis, nonsevere illness: clindamycin 10 days':score>149?'uncertain diagnosis, nonsevere illness: clindamycin 10 days':score>147?'certain diagnosis, severe illness: ceftriaxone 3 days':score>144?'uncertain diagnosis, severe illness: ceftriaxone 3 days':score>142?'certain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>139?'uncertain diagnosis, nonsevere illness: amoxicillin-clavulanate 10 days':score>137?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>134?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>132?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>129?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>127?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>124?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>122?'certain diagnosis, nonsevere illness: amoxicillin 10 days':score>119?'uncertain diagnosis, nonsevere illness: amoxicillin 10 days':score>117?'certain diagnosis, severe illness: consider tympanocentesis or clindamycin':score>114?'uncertain diagnosis, severe illness: consider tympanocentesis or clindamycin 10 days':score>112?'certain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>109?'uncertain diagnosis, nonsevere illness: azithromycin 5 days or clarithromycin 10 days':score>107?'certain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>104?'uncertain diagnosis, severe illness: amoxicillin-clavulanate 10 days':score>102?'certain diagnosis, nonsevere illness: amoxicillin 10 days':'uncertain diagnosis, nonsevere illness: amoxicillin 10 days'
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