Antimicrobial Prescribing Case
A mum brings her 5 year old daughter in to be seen for complaints of right ear pain for
the last 3 days.  One of your partners saw the patient 2 days ago and diagnosed ear
inflammation at that time.  He told the patient’s mum to watch her carefully and to return
if her symptoms did not improve over the next 2 days.  Since that visit, the child [whose
name is Charlotte], has continued to have an earache, and she now has a fever.  Her
PMH is remarkable for one prior ear infection when she was 3 years old.
On exam, this child has flushed cheeks; her oral temperature is 101 degrees; her heart
rate, respirations and blood pressure are normal.  She stands 38 inches tall and weighs
36 pounds
The right tympanic membrane is bulging and inflamed; nasal turbinates’ are swollen;
throat and conjunctiva are unremarkable.  There is no lymphadenopathy to the neck.
Charlotte takes no routine medications; she is allergic to PCN [rash]
She has a younger brother who has no symptoms; he goes to daycare.  She lives with
her parents in a home.  Her mum is a high school teacher; her father is a computer
programmer.  Her father smokes cigarettes.