First-line treatment for acute otitis media (AOM) in children primarily involves symptomatic management rather than immediate antibiotic use. The UK guidelines recommend a cautious approach to antibiotics, reserving them for children with severe symptoms, very young children, or those at risk of complications, rather than routine use for all cases NICE NG233.
Initial management typically includes analgesia with paracetamol or ibuprofen to relieve pain and fever. This approach aligns with consensus recommendations emphasizing symptom control as the cornerstone of early treatment Hoberman et al. 2002.
Antibiotics may be considered if symptoms worsen or do not improve after 48-72 hours, or in children under 2 years with bilateral AOM or otorrhoea. When antibiotics are indicated, amoxicillin is generally the first choice due to its efficacy and safety profile NICE NG233; Marchisio et al. 2019.
Observation with safety-netting advice is encouraged for most children, allowing time for spontaneous resolution while ensuring parents know when to seek further medical review. This strategy reduces unnecessary antibiotic use and antibiotic resistance Sih & Bricks 2008.
Other treatments such as corticosteroids, antihistamines, or decongestants are not recommended for AOM in children due to lack of evidence of benefit NICE NG233.
Key References
- NG233 - Otitis media with effusion in under 12s
- (Hoberman et al., 2002): Treatment of acute otitis media consensus recommendations.
- (Sih and Bricks, 2008): Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media.
- (Marchisio et al., 2019): Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention.