What is the first-line antibiotic for uncomplicated acute otitis media in children aged 2–12 years?

• A. High-dose amoxicillin
• B. Azithromycin
• C. Amoxicillin-clavulanate
• D. Cefdinir

Answer: (A)

High-dose amoxicillin is the best first-line option for uncomplicated acute otitis media in a healthy child aged 2–12 because it reliably targets the common ear pathogens, especially Streptococcus pneumoniae, and the higher dose ensures sufficient drug reaches the middle ear even when some strains show reduced penicillin sensitivity. This approach uses a narrow, effective antibiotic with a favorable safety and cost profile, maximizing cure rates while minimizing broader-spectrum overuse.

Azithromycin is avoided as the first choice because pneumococcus resistance is higher and middle-ear penetration is not as reliable, reducing its effectiveness in AOM. Amoxicillin-clavulanate broadens coverage to beta-lactamase–producing organisms, but it brings more side effects and cost, so it’s typically reserved for specific circumstances such as treatment failure on amoxicillin, recent antibiotics, or particular risk factors. Cefdinir can be an alternative if a penicillin allergy or intolerance is present, but it isn’t preferred in uncomplicated cases due to similar efficacy with potentially more GI effects and higher cost.

Recommended dosing for the first-line option is about 80–90 mg/kg/day of amoxicillin, divided twice daily, for 5–7 days depending on age and severity.