A 2-Year-Old Boy Is Brought to the Office for Evaluation

A 2-year-old boy is brought to the office for evaluation of right ear pain.  Two days ago, his mother saw him put a small rock in his ear while he was playing outside.  She pulled it out and rinsed his ear thoroughly with soapy water in the bath that evening.  The patient had no pain that night, but the next morning he woke up crying and pulling on his ear.  He has been fussy and has not slept well since then.  The patient has had 2 previous episodes of acute otitis media that resolved with antibiotics.  Immunizations are up to date.  Temperature is 37 C (98.6 F) , blood pressure is 90/50 mm Hg, and pulse is 100/min.  Examination shows a somewhat anxious child.  There is no rhinorrhea.  Physical examination of the oropharynx shows normal tonsils with no exudate or erythema.  There is no cervical adenopathy.  The patient cries during examination of the right ear, which reveals a tender, swollen ear canal.  Although only a part of the tympanic membrane is seen, it appears normal.  The left ear is normal.  Which of the following is the most appropriate treatment for this patient's condition?

A) Oral amoxicillin/clavulanic acid
B) Oral fluconazole
C) Oral trimethoprim-sulfamethoxazole
D) Topical ciprofloxacin
E) Topical clindamycin
F) Topical nystatin

Correct Answer:

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