First line:

60% of cases resolve within 24 hours without antibiotics; consider a 2 or 3-day delayed antibiotic prescription.

Second line:

Amoxicillin oral 1g 8 hourly for 5 days 

or

Clarithromycin oral 250-500mg 12 hourly for 5 days

N.B. Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus or tacrolimus.

60% of cases resolve within 24 hours without antibiotics; consider a 2 or 3-day delayed antibiotic prescription.

• Acute otitis media is characterised by unilateral ear ache and a bulging, inflamed tympanic membrane, and with fluid in the middle ear. It may result in perforation of the tympanic membrane, resulting in purulent discharge. 
• Meningitis and mastoiditis are rare complications and if these are suspected the patient should be referred for inpatient treatment.
• If there is purulent discharge in the ear canal, take a swab for culture.
• Offer an immediate antibiotic prescription to patients with purulent otorrhoea.