From the Guidelines
For adult ear infections, high-dose amoxicillin/clavulanate (4 g/250 mg per day) or a respiratory fluoroquinolone (eg, gatifloxacin, levofloxacin, moxifloxacin) are recommended as the first-line antibiotic treatment. According to the study 1, these antibiotics have a predicted clinical efficacy of 90% to 92% for adults. The choice of antibiotic depends on the severity of the infection and whether the patient has received antibiotics in the previous 4 to 6 weeks.
Key Considerations
- For adults with mild disease who have not received antibiotics in the previous 4 to 6 weeks, amoxicillin/clavulanate (1.75 to 4 g/250 mg per day), amoxicillin (1.5 to 4 g/day), cefpodoxime proxetil, cefuroxime axetil, or cefdinir are also appropriate choices 1.
- For patients with β-lactam allergies, TMP/SMX, doxycycline, azithromycin, clarithromycin, erythromycin, or telithromycin may be considered, but bacteriologic failure rates of 20% to 25% are possible 1.
- Failure to respond to antimicrobial therapy after 72 hours should prompt either a switch to alternate antimicrobial therapy or reevaluation of the patient 1.
Treatment Duration and Pain Management
- The treatment duration is typically 7-10 days, but may vary depending on the severity of the infection and the patient's response to treatment.
- Pain management with over-the-counter analgesics like acetaminophen or ibuprofen is also essential to alleviate symptoms.
- Ear drops containing antibiotics with or without steroids might also be prescribed, especially for outer ear infections.
From the Research
Antibiotic Choice for Ear Infection in Adults
- The provided studies primarily focus on the treatment of acute otitis media (AOM) in children, with limited direct relevance to adults 2, 3, 4, 5, 6.
- However, the antibiotics discussed in these studies, such as amoxicillin, amoxicillin-clavulanate, azithromycin, and cefdinir, are also commonly used to treat ear infections in adults.
- A study from 2022 compared the effectiveness of different antibiotic agents, including amoxicillin, amoxicillin-clavulanate, cefdinir, and azithromycin, in treating uncomplicated AOM in children, and found that treatment failure and recurrence rates were low for all agents, with amoxicillin having the lowest rates 6.
- Another study from 2013 found that once or twice daily doses of amoxicillin, with or without clavulanate, were comparable to three or four daily doses in treating AOM in children 3.
- A 1990 study compared the efficacy of twice-daily trimethoprim-sulfamethoxazole and amoxicillin-clavulanate in treating AOM in children, and found that trimethoprim-sulfamethoxazole was more effective and had fewer side effects 4.
- A 2023 systematic review compared the efficacy of antimicrobials or placebo to amoxicillin-clavulanate in children with AOM, and found that amoxicillin-clavulanate was superior to some antimicrobials, but its efficacy was comparable to others 5.
- A 2000 study compared the bacteriologic and clinical efficacy of amoxicillin-clavulanate and azithromycin in treating AOM in children, and found that amoxicillin-clavulanate was more effective in eradicating bacterial pathogens, including Haemophilus influenzae and Streptococcus pneumoniae 2.