Liam Wilson Case Studies

Prescriptive Case Study One Liam Wilson is a healthy, vaccinated, 19-month-old boy with a prior history of acute otitis media (AOM) at 11 months. Liam’s treatment with amoxicillin HD for his first AOM was successful, but after the eighth dose, a rash appeared on his trunk and extremities, but had no evidence of anaphylaxis. At his visit today, Liam’s mother reports crying and tugging of the right ear for two days, along with decreased appetite, decreased playfulness, and difficulty sleeping for three days. She also noticed that Liam felt very warm to the touch, but she does not have a thermometer at home for monitoring. Liam’s mother stays at home, taking care of Liam and his healthy older sister. Liam continues to use pacifiers to fall asleep during afternoon naptime and at bedtime. Both parents are smokers. Currently, Liam has an elevated, un-medicated temperature of 103.6 F. His physical exam reveals bilateral erythematous tympanic membranes (TM), with the right ear being worse. The right TM is bulging with copious cerumen and questionable purulent fluid behind the TM, but the TM landmarks appear normal bilaterally. His throat is erythematous and the nares are draining thick, yellow mucus. Liam’s diagnosis is a right AOM, and the following paragraphs

If the diagnosis is uncertain, the text recommends antibacterial therapy if illness is severe, meaning AOM presents with moderate to severe otalgia or fever of 39°C (102.2°F) or higher. A high-dose amoxicillin at 40–45 mg/kg twice daily is the first treatment of choice due to its cost, taste, safety, and effectiveness. The duration of treatment depends on the patients’ age and the severity of illness and can range from 5 to 10 days. For patients with a penicillin allergy, drug selection process depends on the severity of the reaction (Burchum & Rosenthal,