A 4-year-old with signs of acute otitis media should receive which first-line antibiotic?

• A. Amoxicillin/Clavulanate (Augmentin)
• B. Amoxicillin (Amoxil)
• C. Cefaclor (Ceclor)
• D. Trimethoprim-sulfamethoxazole (Septra)

Answer: (B)

High-dose amoxicillin is the best first-line antibiotic for acute otitis media in a healthy preschool-aged child. It effectively treats the three most common culprits—Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis—and using a high dose ensures adequate drug levels to overcome many strains of penicillin-nonsusceptible pneumococcus. The typical plan is about 80-90 mg/kg/day given in two divided doses for around 7 days in children older than 2 years. Amoxicillin-clavulanate is reserved for cases with risk factors for beta-lactamase–producing organisms or recent antibiotic use, or when there’s treatment failure with amoxicillin. Other choices like trimethoprim-sulfamethoxazole or cefaclor are not preferred first-line due to poorer pneumococcal coverage or safety/tolerability concerns.