Which medication is first-line treatment for acute otitis media?

Amoxicillin is the first-line treatment for acute otitis media due to its effectiveness against the most common pathogens implicated in this condition, particularly Streptococcus pneumoniae and Haemophilus influenzae. It works by inhibiting bacterial cell wall synthesis, which leads to the death of the bacteria. This makes it a suitable option for children and adults who present with uncomplicated cases of acute otitis media, as it has a favorable safety profile, good penetration into the middle ear, and is often well-tolerated.

Using other antibiotics like ceftriaxone can be reserved for cases where patients have persistent symptoms, are at risk for complications, or have a high likelihood of resistant infections. Azithromycin and clarithromycin, while effective against certain bacteria, are generally not first-line due to issues with resistance and lesser efficacy against Streptococcus pneumoniae compared to amoxicillin. Therefore, amoxicillin remains the preferred option for initial treatment in most cases of acute otitis media.