Acute otitis media 
This is caused by infection in the air space behind the ear drum (middle ear) and is very painful. It is associated with a temperature and can lead to discharge from the ear if the ear drum perforates. Often the pain is severe at night and the child can be very unsettled. This type of infection is especially common in children under the age of two years of age 
It is common in children and most children will experience at least one ear infection like this. 
In the past, antibiotics were routinely prescribed for each infection but it is now the case that management will often be with pain relief, with antibiotics reserved for specific indications. 
Recurrent Acute otitis media 
Some children are unfortunate to experience repeated infections due to acute otitis media. 
In this case strategies to try and prevent ongoing issues need to be considered. 
Essentially there are three options; 
1 Continue to manage each infection as and when ot occurs, safe in the knowledge that the problem will settle as the child grows older. 
2 Consider grommets insertion- this can reduce the number of infections that occur but not necessarily prevent them altogether. In this setting grommets can also be a problem as they can block or fall out much earlier that when placed for the treatment of glue ear. The NHS has restricted the use of grommets and in this setting it is a requirement that the child has a certain number of documented ear infections with their GP- see mid Notts Restricted Procedures 
3 Treat with long-term low dose antibiotic with the aim of breaking the cycle of repeated infections. In this setting we commonly prescribe azithromycin 10mg/kg once per week (and up to three times per week) for eight weeks initially.  
Regardless of which option is pursued it is important that the child is not exposed to the effects of passive smoking. In addition the use of dummies has been associated with increased risk of ear infections and should be avoided if possible.  
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