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Xavier is a 22 month old boy who attends with his mother who is worried he may have an ear infection. He has been pulling at his right ear recently and complaining it hurts. He had a runny nose yesterday and a fever of 37.6℃ at night. He is otherwise well and has been eating and drinking as normal with the usual number of wet and dirty nappies.

On examination you note a bulging tympanic membrane on the right and observations are all normal.

Based on the likely diagnosis, what feature in the history would prompt you to consider a course of antibiotics?

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