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Writer's pictureConcise Curated Counselling

EAR INFECTION AFFLICTION

Updated: Dec 14, 2023

We're covering an easy-to-intervene issue today!

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1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer

3. Quick Wrap-up

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.


Counselling Conundrum: "My Doctor gave me this prescription for amoxicillin for my child's ear infection (dose is 50 mg/kg/day X 10 days). I have had issues where the prescription was not what it should be in the past. Is this one correct? My child is 6 years old, and she is in daycare, the last ear infection was over a year ago, and the doctor said it's just a simple ear infection."

Concise Conclusion: Ideally this is something that all pharmacists should automatically check for you, but it's never a bad idea to take charge of your child's healthcare. Because your child is in daycare (which makes it more likely that the infection will be resistant), this prescribed dose is on the low side, and I would only do it for 5-7 days since your child is 6 years old. I will take care of this for you.

Quick Wrap-up: It's no wonder prescribers get this wrong; it can be confusing to navigate differing guidelines. Here are our tips: for duration, stick to 10 days if the child is under 2 years old, and 5-7 days otherwise, assuming it is considered uncomplicated (assuming we' re using amoxicillin, the first-line agent. Complicating factors would include acue otitis media [AOM] in the last month, perforated ear drum, etc). For dose, stick to high-dose (75-90 mg/kg/day, usually 80 mg/kg/day) if risk factors for resistance are present, such as antibiotics in past 3 months, daycare (this factor tends to single-handedly include most children), recent AOM, treatment failure, or recurrence. Keep Clavulin as an option if amoxicillin was used in the past month. Reserve macrolides and clindamycin for allergies/other contraindications. We encourage prescribers to simply write how many mg/kg/day and the weight on the Rx and let the pharmacist do the rest, rather than trying to calculate everything on the spot themselves, and also to avoid rounding to easy mL numbers. Lastly, remember that anti-infective guidelines can vary widely by country (due to differences in etiology), so stick to a source that reviews local data (i.e. American references may not apply in Canada).

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We hope you have found this useful. Would appreciate your reply to this email with any feedback or topic suggestions you can; it will be the key to making this newsletter the best it can be.

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