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Patient X: Age 13 months diagnosed with acute otitis media Treatment: Amoxicillin/Clavulanate prescribed for 5 days with consideration to minimize the emergence of antimicrobial resistance Patient Y: Age 12 months diagnosed with acute otitis media Treatment: Amoxicillin/Clavulanate prescribed for 10 days The rate of clinical failure would be ________ in patient X as compared to patient Y.

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Ans is B. The rate of Clinical failure would be LOWER in pt X as compared to previous Y. Age & wt :12 months & 13 months not much difference. In both acute otitis media. In both same antibiotic for Duration 5days vs 10 days With clinical examination & monitoring... With amoxicillin/clavulanate side effects are nausea, vomiting & Diarrhea , abdominal discomfort, skin rashes. Follow up can be done SOS and after on Day 5 Review and if need then can be given for 10 days or 2ndline antibiotic canbe given eg. Cefuroxime/ ceftriaxone/doxycycline/ azytromycine/... Eardrops : ciplox/ oflox / gentamycine ENT surgeon Opinion sos

My ans is A ie higher as drug is prescribed for short period as half life of amoxicillin is less than 6hrs hence optimum results would be only achieved after therapeutic doses given to optimum period earlier withdrawal will lead to resistance

Thanx dr Rakesh Kayasth (pt)
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IN. MY. VIEW MEDICINE. PRESCRIPTION. IS. FOR THE. INFANTS.... PRESCRIPTION. FOR. 10. DAYS. AT. A. STRETCH. STRAIGHTAWAY. . .WITHOUT. FOLLOW. UP ... .... AFTER. 3--5. DAYS.. .. SEEMS. TO. BE IMPRACTICAL SINCE THERE. IS. NO. ESTABLISHED. . .STANDARD / FIXED CRITERIA. FOR. DURATION. OF. . ..TREATMENT. IN. ACUTE. CASES..... ( A O M ). . SO. . IF. AMOXY+ C V... IS. GIVEN. IN. AN INFANT.... FOR. 5. DAYS. WITH. CAREFUL. MONITORING. .. .WILL. SHOW QUICK. RESOLUTION. .. ON. THE. CONTRARY... IF. SAME. TREATMENT. IS. GIVEN. FOR 10. DAYS... .....THE SEVERE. ADVERSE. EFFECTS ...LIKE DIARRHEA. AND. DIAPER. DERMATITIS RASHES WILL. BE. OBSERVED.. AND WILL. SHOW. SUPERADDED. INFECTION SO. .. SUITABLE. OPTION... IS B LOWER

Comparable. At such little age not side effects or resistant to antibiotics is possible except allergy or reaction.

Thanks Dr Shivraj Agarwal
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The rate of clinical failure in Patient X is lower than Patient Y. since unduly overexposure of drug for longer period of time causes resistance to organism thru gene mutation and modification within organism. secondly overexposure will cause alteration of microflora of intestine which r first defence in body against organism invasion. in infant gut flora helps in creating acidic ph of intestines by producing lactic acids which help in inhibiting the growth of other micro organism. so i will go with B.

Thanks for ur appreciation Dr Md Altaf Hussain..
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X WILL BE CURED EARLIER AS ANTIBIOTICS IS GIVEN FOR RIGHT PERIPD OF TIME AND IF TRAGUS SIGN IS POSTIVE GO WITH IBUGESIC PLUS 5 ML T.I.D ...

-Higher- -The child of 12 moths weighs around 9kg -And there is not much difference of weight between 12 and 13 months -Clinical failures are usually seen when the dosage is too low. If we have achieved the therapeutic value then usually Clinical failures are not seen.

We have started same antibiotic in both cases we should prescribe for 5 days and wait for response if patient remain good if not we can have c/s of pharynx and start as per finding of c/s

Comparable.. and A

Thanks doctor Ashok neel
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And A) is right

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