I am encouraged by the strong support for "safety-net prescriptions" and
frequently use them as an opportunity to educate and also prevent dissatisfaction
on the part of agenda-driven parents. It side steps a battle in an area
without clear lines (as opposed to URI, etc).
I usually offer something for perforated otitis as parents find it very
difficult to ignore what is only too visible. Having said that, I recently proudly
ignored a draining otitis in my two year old. After three days, my (nurse
practitioner) wife finally explained to me that it was draining more and was
beginning to smell badly. Here the stakes were a bit higher as I could not simply
refuse and discharge my wife. Once we started oral antibotics, the drainage
rapidly declined. While I am sure it would have resolved spontaneously, I
suspect with my n of 1 that it was more rapid. As was my return to marital bliss.
Does anyone have any data on the natural course of perforated otitis. Is
resolution of "ignored" and draining ears of typically short duration. Do
antibiotics have a role in shortening the course?
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