the literature and guidelines suggest that no antibiotic outperforms amoxicillin as the first-line drug to treat AOM in patients who are not allergic to penicillin Higher-dose amoxicillin (80 to 90 mg/kg/day) in two divided doses for to 10 days has been shown to be more effective than standard dosing (40 mg/kg/day) in that it overcomes the minimum inhibitory concentrations of penicillin to kill intermediate and some highly resistant strains of S pneumoniae Initial therapy in uncomplicated AOM in patients who have type hypersensitivity (anaphylaxis or history of hives) to penicillin should be treated with a cephalosporin Those with similar reactions to cephalosporins should be treated with a macrolide or possibly clindamycin TABLE 118.1 OPTIONS FOR THE TREATMENT OF ACUTE OTITIS MEDIA (AAP/AAFP) GUIDELINES Child age Severe disease a Younger than mo Antibiotics mo–2 yrs Antibiotics yrs or older Antibiotics a Severe Mild or moderate disease b Antibiotics Antibiotics or observation Antibiotics or observation disease: fever >39°C and/or moderate to severe otalgia illness: fever