A 10-month-old girl is brought to her pediatrician’s office because she has been febrile and irritable. She is the product of a normal pregnancy and has been healthy since birth. Yesterday, her parents noticed that she was fussy, less active, and did not eat as much as usual. Overnight she developed a temperature of 38.5°C (101.3°F) and was awake crying for most of the night. Her parents report that she has also been tugging on her left ear. Her temperature is 39°C (102.2°F), respiratory rate is 24/min, and pulse is 140/min. She is not toxic appearing but continues to be irritable. Her pupils are equally reactive to light bilaterally. She has moist mucous membranes, and her pharynx is nonerythematous. The left tympanic membrane is bulging, erythematous, and immobile on pneumatic otoscopy. The right tympanic membrane is mobile and nonerythematous.
She does not have a rash or a history of ear infections.
Her immunizations are up to date.
What is the most appropriate next step in management?
(A) Observation
(B) Refer the patient to a surgeon for myringotomy and placement of tympanostomy tubes
(C) Refer the patient to the emergency department of a tertiary care facility
(D) Start 90 mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate for 10 days
(E) Start amoxicillin at 80–90 mg/kg/day for10 days
(F) Start erythromycin and sulfisoxazole at 50– 150 mg/kg/day for 10 days