When a perforated tympanic membrane presents with discharge that raises clinical concern for concurrent middle ear infection — and the patient has no penicillin allergy — a specific, structured management pathway applies. The approach goes beyond simple wound care to address the underlying infection directly.
This protocol is indicated for patients with tympanic membrane perforation where the character of discharge is suspicious for middle ear infection, confirmed by the absence of penicillin allergy. Microbiological sampling is a required initial step before definitive treatment is started.
Management begins with ear cleaning and microbiological assessment, followed by a combined antibiotic strategy involving both a topical ear preparation and an oral antibiotic agent. The complete regimen — including drug selection, dosing, route, and duration — is detailed in the full structured protocol.
The primary target is clinical response of the middle ear infection within 48–72 hours of initiating treatment.
If discharge suspect middle ear infection, require MCS and micro-suction then Ciprofloxacin 0.3% ear drops 5 drops BD, as well as Amoxicillin (15mg/kg) up to 500mg orally 8 hourly for 5 days
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