What is the first-line treatment for acute otitis media in most cases?

Amoxicillin is the first-line treatment for acute otitis media in most cases due to its effectiveness against the most common bacterial pathogens responsible for the infection, primarily Streptococcus pneumoniae and Haemophilus influenzae. This antibiotic has a solid safety profile, is well-tolerated by patients, and is typically the preferred choice because it adequately covers the usual bacterial flora without the need for broader-spectrum coverage in uncomplicated cases.

Amoxicillin is also generally recommended because it has a favorable pharmacokinetic profile, allowing for good penetration into the middle ear space, which is crucial for treating middle ear infections. The current guidelines emphasize its use unless there are specific contraindications, such as a known allergy to penicillin or if the patient presents with either a severe infection, certain risk factors for antibiotic resistance, or a failure to improve after initial treatment with amoxicillin.

In cases where patients have had recurrent infections or have risk factors for resistant bacteria, alternative treatments like amoxicillin-clavulanate may be necessary, but this is typically reserved for more complicated cases.