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

The recommended first-line treatments for acute otitis media in children include pain relief with paracetamol or ibuprofen, which are more effective than placebo at 48 hours, with a number needed to treat of 7 for paracetamol and 6 for ibuprofen ¹.

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

In children who are systemically unwell, have signs of a more serious illness, or are at high risk of complications, an immediate antibiotic prescription should be offered ¹.

When antibiotics are indicated, amoxicillin is considered the most appropriate first-line choice, with a course duration of 5–7 days ¹.