Younger children and those with multiple AOM that year had higher risk for developing Otitis media associated with the conjunctivitis. Up to 25% of patients with conjunctivitis have concurrent otitis media (even in the abscence of ear pain) and up to 73% of patients with purulent conjunctivitis. Non-typeable H. influenzae is the most common recovered bacteria. For these patients, systemic (oral) antibiotics are recommended and the topical ophthalmic antibiotics are NOT necessary. Antibiotics should cover beta-lactamase producing organisms, e.g. high dose amoxicillin-clavulanic acid (45 mg/kg BID).
Every patient with conjunctivitis should have an examination of his/her tympanic membraness, as your management may change.