Finally, something to offer in cases of acute infective diarrhoea other than telling patients to wait it out – probiotics. Although they don’t do anything dramatic, they do reduce duration of acute gastroenteritis by about a day on average, as well as reducing stool frequency on day 2 by about a fifth. It doesn’t appear to matter which strain you use.
My strategy of prescribing antibiotics directly to children whose OM has perforated, rather than waiting the requisite one to three days, is, it appears, quite reasonable. I may also wish to consider immediate prescribing in under-2s with bilateral OM. When I do prescribe, it seems 5 days is usually sufficient for acute OM and 7 days for sinusitis (not that I can remember when I last prescribed for a child with sinusitis, but good to know just in case). If amoxicillin doesn’t work, co-amoxiclav is an appropriate second-line treatment, and may be considered first-line in children who had amoxicillin in the previous two to three months due to high rates of resistance in such children (although I’m not sure the microbiologists would be thrilled with that plan).