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M09 NHG Clinical Practice Guideline Acute Otitis Media (AOM)

Key messages
  • In general the natural course of Acute otitis media (AOM) is mild and the condition has a favourable outcome. The intervention of GPs can be limited to providing information and prescription of pain relief.
  • Antibiotic treatment is indicated in cases of severe or increasing illness or in the case of risk factors for complications.
  • Consider antibiotic treatment in those children who show no improvement after three days.
  • Consider antibiotic treatment in children with an episode of acute otitis media with otorrhoea at initial presentation and in children below the age of two with bilateral acute otitis media.
Joost Blijham

M29 NHG Clinical Practice Guideline Feverish illness in Children

Key messages
  • Fever is usually caused by a viral infection. Recognising children with a serious underlying disease in time is important.
  • Warning symptoms are more important than the height of the fever.
  • Children under the age of 3 months are at higher risk of a serious underlying disease.
  • Temperature measurements in children under the age of 3 months must be verified rectally.
  • A distinction is made between observations by parents and assessment by the GP. The parents/caregivers need to watch out for alarm symptoms; the GP assesses whether there are warning symptoms that can be objectified.
  • Information about the child's past medical history is requested during telephone triage.
  • In children under the age of 2 with fever without apparent source, after history-taking and physical examination, urine testing should now be performed on the same day.
  • In cases of fever without apparent source, reappraisal is recommended within 24 to 48 hours.
  • A typical febrile convulsion is a benign condition.
Joost Blijham
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