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

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 ¹.

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 ¹; (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 and Bricks, 2008).

Other treatments such as corticosteroids, antihistamines, or decongestants are not recommended for AOM in children due to lack of evidence of benefit ¹.