Here is Treatment: Perforated Acute Otitis Media (AOM with tympanic membrane perforation)

Perforated Acute Otitis Media (AOM with tympanic membrane perforation) is treated slightly differently from uncomplicated AOM because the perforation allows topical therapy to reach the middle ear.

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1. First-line Treatment

A. Topical Antibiotic Ear Drops (Most Important)

Use quinolone ear drops because they are safe in perforated TM.

• Ofloxacin ear drops
  • Dose: 5 drops in affected ear twice daily
  • Duration: 7–10 days

OR

• Ciprofloxacin ear drops
  • Dose: 4–5 drops twice daily
  • Duration: 7–10 days

Avoid aminoglycoside drops (e.g., Gentamicin, Neomycin) because they can be ototoxic if TM is perforated.

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2. Oral Antibiotics (if indicated)

Give systemic antibiotics if:

• Moderate/severe infection
• Fever
• Young child (<2 years)
• Bilateral disease
• Systemic symptoms

First line:

• Amoxicillin
  • 80–90 mg/kg/day divided BID
  • Duration 7–10 days

If severe infection or recent amoxicillin use:

• Amoxicillin‑clavulanate
  • 90 mg/kg/day (amoxicillin component)

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3. Analgesics

• Paracetamol 10–15 mg/kg every 6 hours
  OR
• Ibuprofen 10 mg/kg every 8 hours

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4. Local Care

• Keep ear dry (no water entry).
• Do not plug ear tightly.
• Gentle ear toilet/suction if discharge excessive.

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5. Follow-up

• Re-examine after 1–2 weeks.
• Most perforations heal spontaneously within 2–4 weeks.
• If persistent perforation >6 weeks → ENT referral.

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6. Red Flags (Refer ENT)

• Persistent otorrhea >2 weeks
• Suspected mastoiditis
• Hearing loss
• Recurrent perforations

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Example Pediatric Prescription

• Ofloxacin ear drops: 5 drops BD × 7 days
• Amoxicillin: 80–90 mg/kg/day divided BD × 7 days
• Paracetamol: 10–15 mg/kg every 6 hr PRN pain