However, acute otitis media should not be treated routinely with antibiotics. As with sore throat, antibiotics only have a small impact on the duration of acute symptoms, which can be controlled equally effective with paracetamol. If an antibiotic is to be prescribed a 5-day course is sufficient; the antibiotic of choice is amoxicillin; erythromycin and coamoxiclav are logical alternatives and may be necessary if β-lactamase-producing H. influenzae is involved. Decongestants, antihistamines, and mucolytics are not effective. As with sore throat, patient information leaflets and delayed antibiotic prescriptions are effective strategies for reducing the unnecessary use of antibiotics.
Glue ear is an inflammation of the middle ear with accumulation of fluid in the middle ear but without symptoms or signs of acute inflammation. It is often asymptomatic and earache is uncommon. On examination a middle ear effusion is present but with a normal looking ear drum. Antibiotics should not be given.