What are the recommended treatment options for a patient with acute otitis media who is allergic to penicillin?

For a patient with acute otitis media (AOM) who is allergic to penicillin, the recommended treatment options include using alternative antibiotics that are effective against common pathogens but do not belong to the penicillin class. Macrolides (such as clarithromycin or erythromycin) or a cephalosporin with a low risk of cross-reactivity (such as cefuroxime) may be considered, depending on the severity of the allergy and local resistance patterns. Supportive care with analgesics and antipyretics is also important to manage symptoms. The UK NICE guidelines on otitis media primarily focus on antimicrobial prescribing strategies for AOM but emphasize cautious use of antibiotics, reserving them for more severe cases or those at risk of complications NICE NG233. In patients allergic to penicillin, macrolides are commonly recommended alternatives in clinical practice, supported by antimicrobial treatment guidelines for related upper respiratory infections Anon et al. 2004. It is important to confirm the nature of the penicillin allergy to avoid unnecessarily broad-spectrum antibiotic use. If symptoms are mild, watchful waiting with symptomatic treatment may be appropriate, as many AOM cases resolve spontaneously NICE NG233.