Pharmacy First Pathway Editor

Acute Otitis Media (Pharmacy First)

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YesYesNoModerate/SevereNot pregnantPregnant0>=1Yes>=100No penicillin allergyPenicillin allergyPregnantNot pregnantMild>=100>=1>=1NoNo penicillin allergyPenicillin allergyNo
Outcome

Supply amoxicillin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_amoxicillin outcome info
Outcome

AOM less likely — otoscopic findings do not support diagnosis. Consider alternative diagnosis and proceed appropriately.

outcome_not_aom outcome info
Outcome

AOM less likely — symptomatic findings do not support diagnosis. Consider alternative diagnosis and proceed appropriately.

outcome_not_aom_copy info
Referral

Urgent: call 999 or signpost patient to A&E immediately. Emergency red-flag features identified. Consider calculating NEWS2/PEWS Score.

outcome_emergency referral info
Referral

Patient is not eligible for this pathway. Refer to prescriber or appropriate service.

outcome_not_eligible referral info
Outcome

Self-care and pain relief.

outcome_self_care outcome info
Referral

Onward referral — General practice or other provider as appropriate. Patient has complications requiring prescriber assessment.

outcome_complication_referral referral info
Outcome

Supply erythromycin for 5 days.

outcome_erythromycin outcome info
Outcome

For moderate-severe ear pain with intact eardrum. Symptomatic relief only — does not treat the underlying infection. Supply phenazone 40mg/g + lidocaine 10mg/g ear drops for up to 7 days. Plus self care.

outcome_ear_drops_copy_0 info
Question

Screen for emergency symptoms and serious complications. Select ANY that apply.

emergency_screen decision select_multiple
Outcome

Supply amoxicillin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_amoxicillin_copy_1773430314669_0 info
Outcome

Supply clarithromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_clarithromycin_3 info
Outcome

Supply erythromycin for 5 days.

outcome_erythromycin_4 info
Question

Is the patient pregnant (aged 16–17)?

pregnancy_check_2 select
Question

Reported penicillin allergy (via National Care Record or Patient/Carer)?

allergy_check_copy_1773430314738_1 select
Question

Reported penicillin allergy (via National Care Record or Patient/Carer)?

allergy_check decision select
Question

Is the patient pregnant (aged 16–17)?

pregnancy_check decision select
Outcome

Supply clarithromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_clarithromycin outcome info
Question

Shared decision making — does the patient have severe symptoms or symptoms for more than 3 days?

shared_decision decision select
Question

Is the patient eligible for the Acute Otitis Media pathway? Select ANY that apply

eligibility decision select_multiple
Question

Symptom check- does the patient have the following symptoms? Select ANY that apply.

symptom_screen select_multiple
Info

Patient presenting with signs and symptoms of acute otitis media

intro_guidance info_panel info
Question

Acute otitis media more likely, offer self care and regular pain relief to all patients. Does the patient have the following complications? Select ANY that apply.

complication_screen checklist select_multiple
Question

Otoscopic examination — does the patient have the following findings? Select ANY that apply

otoscopy checklist select_multiple
Question

Is the child under 2 years AND with infection in both ears?

bilateral_check decision select
Question

Assess symptom severity.

symptom_severity decision select
Question

Does the child/young person have otorrhoea (discharge after eardrum perforation) or eardrum perforation (suspected or confirmed)

otorrhoea_check decision select
Outcome

For moderate-severe ear pain with intact eardrum. Symptomatic relief only — does not treat the underlying infection. Supply phenazone 40mg/g + lidocaine 10mg/g ear drops for up to 7 days. Plus self care.

outcome_ear_drops outcome info

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