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15. (QId - 619) A 4-year-old boy complaining of an earache was brought by his mother to your clinic three days ago. According to the mother, the child has had a cold for a week, fever for 24 hours, and pain in the left ear for eight hours. The boy was extremely irritable and difficult to examine during that visit. His temperature was 38.8C (102F). On otoscopy, you observed a bulging, red, tympanic membrane (TM), which did not move with insufflation. The right TM and the rest of the physical examination was normal. The patient had not received any antibiotics for 30 days. At that time, you prescribed amoxicillin 40-mg/kg po qd for 7 days. The mother returns with her son today, and states that he still has an earache and fever. His temperature is 38.5C (101.3F). The left TM is now pink, but still bulging and immobile. The rest of the boy"s examination is unchanged. What is the best next step in this patient"s management?
A) Discontinue amoxicillin, begin IM ceftriaxone, and refer the boy to an otolaryngologist for urgent tympanocentesis.
B) Discontinue amoxicillin and start amoxicillin/clavulanate for 7 days.
C) Continue the current treatment and reassure the mother that her son will improve within 7 days.
D) Continue amoxicillin and refer the patient to an otolaryngologist for urgent tympanostomy and tubing.
E) Discontinue amoxicillin 40-mg/kg po qd and start amoxicillin 90-mg/kg po qd for 7 days.
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