Dawaa Reference

infectious

Recurrent acute otitis media (grommet referral)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources10 sources

Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/ · Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/ · Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-full.txt) · Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph). The formulary caps amoxicillin at 500 mg per dose for most indications; at the twice-daily schedule this regimen uses, that is 1,000 mg in a day, which is the ceiling applied to the weight table. · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin. · MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.

Verified against10 documents
  • Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/
  • Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/
  • Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-full.txt)
  • Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-clinical.txt)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph). The formulary caps amoxicillin at 500 mg per dose for most indications; at the twice-daily schedule this regimen uses, that is 1,000 mg in a day, which is the ceiling applied to the weight table.
  • Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin.
  • MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Ear pain is the single most reliable clue, though many affected children instead show vague, nonspecific signs. [ear pain]
  • Common nonspecific clues include tugging at the ear, irritability, headache, poor sleep, poor feeding, appetite loss, vomiting, or diarrhea. [diarrhoea · headache · insomnia · irritability · poor appetite · poor feeding · vomiting]
  • About two-thirds of affected children also run a low-grade fever. [fever]
  • Any age is possible, but the peak sits between 6 and 24 months
  • It is the commonest reason a child is given an antibiotic, and yet most episodes settle without one

Signs — what you find (8)

  • Diagnosis needs either moderate-to-severe bulging of the eardrum or new drainage from the ear that isn't from an outer-ear infection.
  • Mild bulging can still count if it's paired with recent ear pain or redness. [ear pain · redness]
  • On otoscopy the drum can look red or normal, with fluid behind it and less movement to a puff of air; clearly bulging pus points to suppurative disease. [pus]
  • Marked swelling of the ear canal itself suggests a coexisting outer-ear infection rather than AOM alone.
  • Swelling, redness, or unusual tenderness over the mastoid bone behind the ear raises concern for mastoiditis. [redness]
  • On tuning-fork testing, bone conduction sounds louder than air conduction on the affected side.
  • Puffing air at the drum is the most reliable way to judge it, and beats plain otoscopy on both sensitivity and specificity
  • Red flag: undertreated it can end in hearing loss, unsteadiness, a perforated drum, cholesteatoma, and rarely mastoiditis, labyrinthitis, meningitis, brain abscess or sinus thrombosis [abscess · hearing loss · unsteadiness]

Tests (7)

  • The typical case is diagnosed without any lab work or imaging.
  • A full sepsis workup may be reasonable for a febrile infant under 12 weeks with no clear source, even though AOM alone doesn't call for it.
  • Temporal bone CT can pick up complications like mastoiditis, abscess, sinus clotting, meningitis, or cholesteatoma.
  • Draining fluid from the eardrum confirms the effusion and lets the fluid be cultured to target antibiotics.
  • That drainage procedure is generally reserved for newborns, immunocompromised patients, or cases where antibiotics have failed or disease is severe.
  • Tympanometry can pick up middle ear fluid but can't reliably tell simple AOM apart from chronic suppurative disease; hearing testing is more useful for recurrent or complicated cases.
  • What makes the call hard: two examiners disagree, the child will not cooperate, and the canal is narrow

If not this — what else fits (4)

  • Cholesteatoma and fever without any clear source also appear on the AOM differential list.
  • Bacterial meningitis in a child is another differential to keep in mind for this presentation.
  • Both the common cold and teething are listed among conditions considered alongside AOM.
  • The middle ear runs a spectrum, and which point it sits at changes what you do: acute, recurrent, with effusion, or chronic suppurative

SourceRecurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-full.txt)

Presentation findings are traced to the source above.

Rx: Antibiotic for the acute episode | Main treatment | Antibiotic when amoxicillin has not worked | Pain and fever

ANTIBIOTIC FOR THE ACUTE EPISODE

1

AMOXICILLIN

Antibiotic for the acute episode

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg three times daily x 10 days, which is the course the article gives for acute otitis media in adults and children alike

Paediatric dose

40-90 mg/kg/day [child max 1000 mg]

(Divided twice or three times daily; use the high end, 80 to 90 mg/kg/day, where pneumococcal resistance is likely, which is the usual assumption in a child who keeps relapsing. The 1,000 mg per day ceiling is the formulary's 500 mg per-dose limit at the twice- daily schedule.)

Dose by weight
3kg120-270 mg/day
4kg160-360 mg/day
5kg200-450 mg/day
6kg240-540 mg/day
7kg280-630 mg/day
8kg320-720 mg/day
9kg360-810 mg/day
10kg400-900 mg/day
11kg440-990 mg/day
12kg480-1000 mg/day (upper capped)
13kg520-1000 mg/day (upper capped)
14kg560-1000 mg/day (upper capped)
15kg600-1000 mg/day (upper capped)
16kg640-1000 mg/day (upper capped)
17kg680-1000 mg/day (upper capped)
18kg720-1000 mg/day (upper capped)
19kg760-1000 mg/day (upper capped)
20kg800-1000 mg/day (upper capped)
21kg840-1000 mg/day (upper capped)
22kg880-1000 mg/day (upper capped)
23kg920-1000 mg/day (upper capped)
24kg960-1000 mg/day (upper capped)
25kg1000 mg/day (capped)
26kg1000 mg/day (capped)
27kg1000 mg/day (capped)
28kg1000 mg/day (capped)
29kg1000 mg/day (capped)
30kg1000 mg/day (capped)
31kg1000 mg/day (capped)
32kg1000 mg/day (capped)
33kg1000 mg/day (capped)
34kg1000 mg/day (capped)
35kg1000 mg/day (capped)
36kg1000 mg/day (capped)
37kg1000 mg/day (capped)
38kg1000 mg/day (capped)
39kg1000 mg/day (capped)
40kg1000 mg/day (capped)
41kg1000 mg/day (capped)
42kg1000 mg/day (capped)
43kg1000 mg/day (capped)
44kg1000 mg/day (capped)
45kg1000 mg/day (capped)
46kg1000 mg/day (capped)
47kg1000 mg/day (capped)
48kg1000 mg/day (capped)
49kg1000 mg/day (capped)
50kg1000 mg/day (capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph). The formulary caps amoxicillin at 500 mg per dose for most indications; at the twice-daily schedule this regimen uses, that is 1,000 mg in a day, which is the ceiling applied to the weight table.

Why

The article makes high-dose oral amoxicillin the antibiotic of choice for a bacterial episode in anyone not allergic to penicillin, on the grounds of the concentration it reaches in the middle ear. Recurrence is not a reason to escalate the agent - each episode is treated as an episode, while the recurrence itself is what earns the surgical referral. The dose here is the same one the acute otitis media card carries, so the two cards cannot drift into two answers.

Cautions
  • Avoid in penicillin allergy. The article's alternatives there are a single 10 mg/kg dose of azithromycin, clarithromycin 15 mg/kg/day in 2 divided doses, cefdinir 14 mg/kg/day, cefpodoxime 10 mg/kg once daily or cefuroxime 30 mg/kg/day in 2 divided doses.
  • PROPHYLACTIC ANTIBIOTICS ARE NO LONGER ADVISED for recurrent acute otitis media. The article says so directly, and sends the child for assessment for tympanostomy tubes instead - so a long low-dose course is the thing not to start here.
  • Reassess at 48 to 72 hours if a child is not responding, which is the article's own interval for reconsidering treatment.
  • Where the eardrum has perforated, the article treats with an ototopical antibiotic safe for middle ear use, such as ofloxacin drops, rather than a systemic antibiotic, because the drops reach far higher concentrations locally. The same applies to a child with functioning grommets who gets an episode, and to uncomplicated discharge from a grommet, for which it prescribes ear drops alone.
  • Reduce the dose in severe renal impairment, and expect a rash if amoxicillin is given during glandular fever.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMOXYCILLIN 500MG 10 CAPS B.P.2013ARAB DRUG COMPANY (ADCO)6.50 EGP (0.65/unit)
AMOXICILLIN 500MG 12 CAPS. USP 28OCTOBER PHARMA8.10 EGP (0.67/unit)
AMOXIL 500MG 12 CAPS.MUP > SMITHKLINE BEECHAM9.00 EGP (0.75/unit)
AMOXICID 500 MG 12 CAPS.CID9.50 EGP (0.79/unit)
E-MOX 500 MG 16 CAPS.EIPICO15.60 EGP (0.97/unit)
HICONCIL 500MG 12 CAPS.PHARCO11.60 EGP (0.97/unit)
BIOMOX 500MG 12 CAPS.SEDICO19.50 EGP (1.62/unit)
IBIAMOX 500 MG 12 CAPS.AMOUN45.00 EGP (3.75/unit)
HICILLIN 125MG/5ML SUSP. 80ML? strength differs? different route - not oral solidEL NASR3.00 EGP
AMOXIL FORT 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidMUP > SMITHKLINE BEECHAM5.50 EGP

MAIN TREATMENT

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Count the episodes: three in six months, or four or more in twelve, is the AAP threshold for an ENT referral to consider grommets. Treat each episode from the acute otitis media entry and reassess at 48 to 72 hours if it has not answered. Do not put the child on months of prophylactic antibiotics - that is no longer advised. Time the referral to the pattern, because a grommet must not be inserted in an ear with no effusion on the day of assessment. Check hearing and speech, not just the drum. Send back sooner for unsettling fever, worsening pain, changed hearing or behaviour, or swelling behind the ear.

Dose source

Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/

Why

Counting the episodes is what turns repeated earache into an ENT referral. A single episode is treated on the acute-otitis-media entry; what belongs here is the threshold for grommets, the fact that long-term antibiotics are no longer the answer, and the modifiable risks worth naming to the family in the meantime.

Cautions
  • THE COUNT THAT TRIGGERS THE REFERRAL - by the AAP guidelines, a child who has had 3 episodes of acute otitis media within 6 months, or 4 or more within 12 months, should be considered for myringotomy and grommet insertion (tympanostomy).
  • DO NOT PUT THE CHILD ON MONTHS OF ANTIBIOTICS INSTEAD - prophylactic antibiotics are NO LONGER advised for a child with recurrent acute otitis media; assess for grommets instead.
  • AND THE EAR HAS TO BE WET ON THE DAY THE ENT SURGEON LOOKS - a grommet must NOT be inserted in a child with recurrent acute otitis media who has no middle ear effusion in either ear when they are assessed for it. An ear that is dry at the appointment can lose the child the operation, so time the referral to the pattern of episodes.
  • WHY THE TUBE HELPS - repeated infections needing antibiotics are, clinically, evidence that the Eustachian tube is not working. A grommet ventilates the middle ear space, brings hearing back to normal, and heads off delay in speech. And a child with a grommet in place who catches another infection can be treated with antibiotic ear drops instead of another course by mouth.
  • COUNT PROPERLY, BECAUSE THE NUMBER PREDICTS THE COURSE - a child who has had fewer than 3 episodes is about 3 times likelier to get better on a single course of antibiotic.
  • RECHECK AT 48 TO 72 HOURS DURING AN EPISODE - a paediatric infection that has not answered the first antibiotic inside 48 to 72 hours is reassessed, with a view to changing the treatment. And where antibiotics are held back in favour of watchful waiting, agree a fallback plan for starting them.
  • THE MODIFIABLE RISKS WORTH NAMING TO THE FAMILY - keeping up with the pneumococcal and influenza vaccines cuts down the upper respiratory infections that so often come before an episode. Carers should also keep the child away from tobacco smoke, second-hand and third-hand alike, which irritates the airway and raises the risk of infection. And breastfeeding, where it is possible, goes with less otitis media, because protective immunoglobulins pass to the child.
  • THE RISKS THAT CANNOT BE CHANGED, BUT EXPLAIN THE PATTERN - no breastfeeding, or not for long. Exposures in the environment - passive smoking, and being in daycare. A lower socioeconomic position. Recurrent acute otitis media in the family, in a parent or a sibling. And an abnormality of the skull or the palate that stops the Eustachian tube working - a cleft palate, or a tensor veli palatini that does not function.
  • AND ONE RISK IS AGE, WHICH THE CHILD GROWS OUT OF - the peak falls at 6 to 12 months of age, and the rate drops away after 5 years, as the angle of the Eustachian tube changes.
  • FLUID BETWEEN EPISODES IS A DIFFERENT PROBLEM WITH THE SAME TREATMENT - a persistent effusion shows on otoscopy as thick amber fluid behind a retracted drum. Both conditions reduce the drum's mobility on tympanometry or pneumatic otoscopy and both cost hearing, which is exactly why one gets mistaken for the other and managed wrongly.
  • STEROIDS AND ANTIHISTAMINES ARE NOT THE ANSWER TO EITHER - neither a systemic steroid nor an antihistamine has been shown to help meaningfully.
  • CHECK THE HEARING AND THE SPEECH, NOT JUST THE DRUM - a referral for speech and language may be needed where delay persists, and particularly after grommets have gone in. Repeated infections in the first years cost a child hearing at the age they are learning to talk.
  • WHEN TO SEND THE CHILD BACK SOONER - fever that will not settle, ear pain getting worse, or any change in hearing or in behaviour, all warrant review. Add to that a swelling or redness behind the ear, which is mastoiditis until proven otherwise.

ANTIBIOTIC WHEN AMOXICILLIN HAS NOT WORKED

3

AMOXICILLIN + CLAVULANIC ACID

Antibiotic when amoxicillin has not worked

2nd line

Strength1000 mg

Formoral.solid

Adult dose and duration

875 mg twice daily, or 500 mg every 8 hours x 10 days

Paediatric dose

80-90 mg/kg/day [child max 4000 mg]

(Of the amoxicillin component, divided twice daily. Use a 14:1 formulation such as AUGMENTIN ES-600 or a 642.9 mg/5 mL suspension, so that clavulanate stays under 10 mg/kg/day at this amoxicillin dose; a 7:1 product at the same amoxicillin dose delivers far too much clavulanate. The article's figure for the clavulanate component at this regimen is 6.4 mg/kg/day.)

Dose by weight
3kg240-270 mg/day
4kg320-360 mg/day
5kg400-450 mg/day
6kg480-540 mg/day
7kg560-630 mg/day
8kg640-720 mg/day
9kg720-810 mg/day
10kg800-900 mg/day
11kg880-990 mg/day
12kg960-1080 mg/day
13kg1040-1170 mg/day
14kg1120-1260 mg/day
15kg1200-1350 mg/day
16kg1280-1440 mg/day
17kg1360-1530 mg/day
18kg1440-1620 mg/day
19kg1520-1710 mg/day
20kg1600-1800 mg/day
21kg1680-1890 mg/day
22kg1760-1980 mg/day
23kg1840-2070 mg/day
24kg1920-2160 mg/day
25kg2000-2250 mg/day
26kg2080-2340 mg/day
27kg2160-2430 mg/day
28kg2240-2520 mg/day
29kg2320-2610 mg/day
30kg2400-2700 mg/day
31kg2480-2790 mg/day
32kg2560-2880 mg/day
33kg2640-2970 mg/day
34kg2720-3060 mg/day
35kg2800-3150 mg/day
36kg2880-3240 mg/day
37kg2960-3330 mg/day
38kg3040-3420 mg/day
39kg3120-3510 mg/day
40kg3200-3600 mg/day
41kg3280-3690 mg/day
42kg3360-3780 mg/day
43kg3440-3870 mg/day
44kg3520-3960 mg/day
45kg3600-4000 mg/day (upper capped)
46kg3680-4000 mg/day (upper capped)
47kg3760-4000 mg/day (upper capped)
48kg3840-4000 mg/day (upper capped)
49kg3920-4000 mg/day (upper capped)
50kg4000 mg/day (capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin.

Why

Beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis are what defeat plain amoxicillin, and they are commoner in a child who has already had several courses. The article's step after high-dose amoxicillin fails is high-dose amoxicillin-clavulanate, and the dose here is the one the acute otitis media card already carries.

Cautions
  • Avoid in penicillin allergy, and avoid entirely if there has been previous cholestatic jaundice with this combination.
  • Diarrhoea is commoner than with amoxicillin alone, and at 90 mg/kg/day it is the usual reason a course is abandoned.
  • Check the ratio on the bottle before writing the dose. This is the one place a paediatric otitis prescription goes wrong.
  • For a child who cannot keep an oral antibiotic down, the article's alternative is ceftriaxone 50 mg/kg/day intravenously or intramuscularly for 3 consecutive days.
  • The article records that systemic steroids and antihistamines have not been shown to help acute otitis media.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.EIPICO14.00 EGP (1.40/unit)
JULMENTIN 2X 1GM 15 TAB.JULPHAR57.50 EGP (3.83/unit)
DEXICLAVE 1 GM 10 F.C. TABS.RAMEDA > NOVELL PHARMA38.50 EGP (3.85/unit)
MACLAVEX 1 GM 14 F.C.TABS.MASH PREMIERE105.00 EGP (7.50/unit)
CLAVIMOX 1 GM 12 F.C.TABS.PHARCO130.00 EGP (10.83/unit)
MEGAMOX 1 GM 14 F.C. TABS.AL JAZEERA PHARMACEUTICAL > HIKMA PHARMA178.00 EGP (12.71/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETSGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP

PAIN AND FEVER - give alongside

4

PARACETAMOL

Pain and fever

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours - Through the painful days of each episode, including at bedtime

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(15 mg/kg per dose three or four times daily from 1 month of age, maximum 60 mg/kg per day. Under 1 month, 10 mg/kg per dose three or four times daily, maximum 40 mg/kg per day. In severe acute malnutrition MSF reduces it to 10 mg/kg up to three times in 24 hours.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg.

Why

The article makes controlling the pain one of the two goals of treating an episode, and names acetaminophen, non-steroidal anti-inflammatory drugs or topical 1% lidocaine, used alone or together, for it. In a child having their fourth episode in a year the pain and the broken nights are what the family came about.

Cautions
  • Give it at bedtime as well - the disturbed sleep is usually what brings the family back.
  • Check every other product the child is taking for paracetamol; cold and flu sachets are the usual route to an accidental overdose.
  • Reduce the maximum in liver disease.
  • Three episodes in 6 months, or four or more in 12 months, is the article's threshold for assessing a child for grommets - and it adds that tubes are not inserted if there is no middle ear effusion in either ear at the time of that assessment, while bilateral tubes are placed where effusion is present.
  • Recurrent episodes are evidence of Eustachian tube dysfunction, and the article's reason for tubes is ventilation of the middle ear, return of normal hearing and prevention of speech delay. Hearing or speech concerns need audiology, not another antibiotic.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.