What is the first line treatment for acute otitis media (OM)?

Amoxicillin is considered the first-line treatment for acute otitis media (AOM) primarily due to its effectiveness against the most common pathogens responsible for this condition, such as Streptococcus pneumoniae and Haemophilus influenzae. Amoxicillin is a penicillin-type antibiotic that provides a good therapeutic index, meaning it is effective at treating the infection while minimizing adverse effects.

The rationale for using amoxicillin as first-line therapy includes its relatively favorable side effect profile, its oral bioavailability, and its ability to penetrate well into the middle ear space. Treatment typically starts with amoxicillin unless the patient has a history of penicillin allergy or has been treated with amoxicillin within the last 30 days, or if the infection is severe or recurrent, in which case alternatives may be considered.

Other options, such as cephalosporins, macrolides, or fluoroquinolones, are generally not first-line treatments for uncomplicated AOM. While they may be appropriate in cases of treatment failure, allergy, or more serious infections, they do not have the same favorable balance between efficacy and side effects for this common condition. Thus, amoxicillin remains the preferred choice in appropriate patients with AOM.