What is the first-line antibiotic for acute otitis media in a child older than 2 years with non-severe symptoms?

• A. Amoxicillin
• B. Cefdinir
• C. Amoxicillin-clavulanate
• D. Azithromycin

Answer: (A)

High-dose amoxicillin is the first-line treatment for uncomplicated acute otitis media in a child over 2 years with non-severe symptoms. The common culprits in this age group are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, and amoxicillin effectively treats these pathogens when given at a higher dose. Using a higher dose increases the chances of overcoming penicillin-intermediate pneumococcal strains, while keeping the spectrum narrow helps limit unnecessary antibiotic exposure. The typical plan is about 5–7 days of therapy, with a high daily dose (80–90 mg/kg/day) divided into two doses. If there’s recent antibiotic use, daycare exposure, or signs of more severe disease, the recommended option shifts to amoxicillin-clavulanate to cover beta-lactamase–producing organisms. Alternatives like cefdinir or azithromycin are generally not preferred as first-line due to lower efficacy or resistance concerns, and are reserved for specific situations such as penicillin allergy or intolerance.