A 6-year-old child with acute otitis media; recommended management?

• A. Amoxicillin; if penicillin allergic or resistant, switch to amoxicillin-clavulanate or cephalosporin.
• B. Observation without antibiotics.
• C. Erythromycin.
• D. Ampicillin.

Answer: (A)

Acute otitis media in a school-age child is best treated with antibiotics to quickly clear infection and relieve pain. High-dose amoxicillin is the first-line choice because it provides strong coverage against the common pathogens (including penicillin-susceptible and some penicillin-resistant Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae) and is effective, well tolerated, inexpensive, and easy to administer. If there is a true penicillin allergy or if there is suspicion of beta-lactamase–producing organisms or treatment failure, the appropriate next step is to switch to amoxicillin-clavulanate or a cephalosporin to broaden coverage and overcome resistance.

Erythromycin is generally avoided due to high resistance among otitis media pathogens, and ampicillin is not favored because many strains are resistant and it does not provide the spectrum needed for this infection. Observation without antibiotics can be considered only in carefully selected cases (certain mild symptoms and reliable follow-up), but in a typical 6-year-old with acute otitis media, antibiotics are preferred to hasten recovery and prevent complications.