From the Guidelines
For an adult with acute otitis media who has anaphylaxis to amoxicillin, I recommend using cefdinir, cefpodoxime, or cefuroxime as a first-line alternative, as these options are clinically effective and have a narrow microbiologic spectrum. According to the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guideline on diagnosis and management of acute otitis media 1, these medications can be prescribed if the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction. The choice of a first-line treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present.
- Key considerations for alternative antibiotics include:
- Efficacy against common pathogens in acute otitis media (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis)
- Local resistance patterns
- Patient-specific factors like kidney function
- Potential drug interactions
- Symptomatic treatment with analgesics such as acetaminophen or ibuprofen should also be recommended for pain relief.
- Patients should complete the full course of antibiotics even if symptoms improve before completion to prevent recurrence or resistance development.
From the FDA Drug Label
Azithromycin (10 mg/kg on Day 1 followed by 5 mg/kg on Days 2 to 5) was compared to amoxicillin/clavulanate potassium (4:1). For the 553 patients who were evaluated for clinical efficacy, the clinical success rate (i. e., cure plus improvement) at the Day 11 visit was 88% for azithromycin and 88% for the control agent. The combined clinical success rate (i.e., cure and improvement) at the Day 11 visit was 84% for azithromycin. The combined clinical success rate (i.e., cure and improvement) of those patients with a baseline pathogen at the Day 11 visit was 88% for azithromycin vs. 100% for control;
For an adult patient with anaphylaxis to amoxicillin, azithromycin can be used as an alternative treatment for acute otitis media. The dosage regimen for adults is not explicitly stated in the provided drug labels, but based on the information provided for pediatric patients, it can be inferred that a similar dosage regimen may be used. However, the exact dosage for adults should be determined by a healthcare professional. 2 2
- Key points:
- Azithromycin is effective in treating acute otitis media
- Azithromycin can be used as an alternative to amoxicillin in patients with anaphylaxis to amoxicillin
- The dosage regimen for adults should be determined by a healthcare professional
From the Research
Alternative Treatments for Acute Otitis Media
If a patient has anaphylaxis to amoxicillin, alternative treatments for acute otitis media in adults can be considered.
- Cefuroxime axetil is an option, as it has been shown to be effective in treating acute otitis media in adults 3.
- Azithromycin can also be used as an alternative, although its efficacy may vary compared to amoxicillin/clavulanate 4, 5.
- Trimethoprim/sulfamethoxazole (TMP/SMX) or high-dose amoxicillin/clavulanate may be considered in cases where the patient is not allergic to these medications 6.
- Ceftriaxone can be reserved as a third-line treatment option 6.
Considerations for Treatment
When selecting an alternative treatment, factors such as clinical efficacy, adverse effects, frequency and duration of administration, taste, cost, comorbid infections, and ramifications of bacterial resistance should be considered 6.