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

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

Answer: (B)

The main idea is to use the most effective but narrow antibiotic for a child over 2 with non-severe acute otitis media. High-dose amoxicillin is preferred because it reliably treats the usual ear pathogens—Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis—with good safety, tolerability, and at low cost. This keeps the spectrum focused and helps reduce antibiotic resistance. Other options are not first-line in this scenario: azithromycin is less effective against pneumococcus and has higher failure rates; cefdinir is a broader, more costly alternative without added benefit when amoxicillin works; amoxicillin-clavulanate is reserved for specific situations such as risk factors for beta-lactamase–producing organisms or recent amoxicillin use or treatment failure.