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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 .

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

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 .

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

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