A 3-year-old boy has fever 104 F and a brief seizure; exam shows the left tympanic membrane is erythematous and bulging. Which is the most appropriate next step?

• A. Give ibuprofen
• B. Give acetaminophen
• C. Start antibiotics
• D. Lumbar puncture

Answer: (A)

Acute otitis media presenting with a bulging tympanic membrane and high fever in a 3-year-old signals a bacterial ear infection that benefits from antibiotic therapy. In children older than 2 with AOM and fever, antibiotics are recommended to shorten illness duration and reduce the risk of complications, especially when the infection is causing systemic symptoms like a high fever. A febrile seizure is a common reaction to fever and does not by itself point to a central nervous system infection; it doesn’t replace the need to treat the ear infection. Use fever-reducing meds such as acetaminophen or ibuprofen for comfort, but don’t delay antibiotics to treat the underlying AOM. Lumbar puncture is not indicated unless there are signs suggesting meningitis.