What are the recommended first-line treatments for acute otitis media in children?

The recommended first-line treatment for acute otitis media in children is most commonly a 5–7 day course of antibiotics, with amoxicillin being the most appropriate choice due to resistance considerations and current practice ¹.

Alternative first-line antibiotics include clarithromycin and erythromycin, with azithromycin reserved for more serious infections ¹.

Most children with AOM improve within 3 days without antibiotics, and a backup antibiotic prescription can be used if symptoms do not improve within this period ¹.

Analgesics such as paracetamol or ibuprofen are recommended for pain relief, although evidence on their comparative efficacy is limited ¹.