How can I differentiate between viral and bacterial otitis media in a primary care setting?

The provided UK guidelines do not offer specific clinical signs or symptoms to differentiate between viral and bacterial otitis media at initial presentation in a primary care setting ¹.

However, if a person's symptoms of acute otitis media (AOM) fail to improve or worsen after 2 to 3 days of antibiotic treatment, it is recommended to reassess them and consider that the symptoms could be due to a viral infection or antibiotic resistance ¹. NICE guidance also advises reviewing treatment if symptoms do not improve within 7 days or worsen at any time ¹.