** Acute otitis media should be treated early and aggressively with antibiotics to prevent chronic suppurative otitis media, which is very difficult to cure once established.**
Treatment guidelines as per the CARPA standard treatment manual:
Chronic suppurative otitis media (CSOM)
- Large perforation with pus (discharge) for more than 2 weeks
- or small perforation and pus (discharge) for 6 weeks or more
- if pus (discharge)started in last 6 weeks - treat as AOMwiP
- Clean with tissue spears or syringe with povidone iodine diluted 1:20
- Give ciprofloxacin ear drops 5 drops 2-4 times a day
- Teach parents to clean /dry mop ears with tissue spears, put in drops
- Talk with parents about stimulating speech and language in young child - lots of talking, going to preschool, child care, early learning program
- Review weekly
- Continue ciprofloxacin until CSOM resolved - no pus for more than 3 days
- If still discharge after 3 months -- persistent CSOM
- Refer to ENT
- Hearing test
- May need IV antibiotic
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