What is the treatment for otitis media in adults?

From the Guidelines

Adults with otitis media should be treated with amoxicillin as the first-line antibiotic, prescribed at a dosage of 80 to 90 mg per kg per day, as it is generally effective against susceptible and intermediate resistant pneumococci. This recommendation is based on the guideline released by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) 1. The choice of amoxicillin is due to its safety, affordability, and narrow microbiologic spectrum.

Key Considerations

• The optimal duration of therapy for patients with otitis media is uncertain, but typically ranges from 5-7 days.
• If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, alternative antibiotics such as cefdinir, cefpodoxime, or cefuroxime can be prescribed.
• Pain management and supportive care are also crucial components of treatment, and may include the use of acetaminophen or ibuprofen for pain relief, and decongestants like pseudoephedrine to relieve ear pressure.

Treatment Approach

• Patients should complete the full antibiotic course even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
• If symptoms worsen or don't improve within 48-72 hours of treatment, patients should seek follow-up care as this may indicate antibiotic resistance or complications.
• Referral to an ENT specialist may be necessary for severe cases or those unresponsive to oral antibiotics.

From the FDA Drug Label

Acute Otitis Media (total dosage regimen: 30 mg/kg, see DOSAGE AND ADMINISTRATION) Safety and effectiveness in the treatment of pediatric patients with otitis media under 6 months of age have not been established

The FDA drug label does not answer the question about otitis media treatment in adults.

From the Research

Otitis Media Treatment in Adults

• The provided studies primarily focus on the treatment of otitis media in children, with no direct evidence for adult treatment 2, 3, 4, 5, 6.
• However, the recommended first-line drug for otitis media is amoxicillin, which may also be applicable to adults 2, 4.
• Effective second-line drugs for resistant beta-lactamase-producing bacterial strains include trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime 2.
• The choice of antibiotic should consider proven efficacy, cost, side effect profile, compliance issues, spectrum of coverage, and patient age 2.
• There is no direct evidence to support the use of specific antibiotics in adults, but amoxicillin/clavulanate has been shown to be effective in children with acute otitis media 5, 6.

Antibiotic Resistance and Treatment

• The high prevalence of drug-resistant S. pneumoniae and beta-lactamase-producing organisms presents a clinical challenge for practitioners in selecting empiric antimicrobial therapy 4.
• Pharmacokinetic/pharmacodynamic principles should be considered in addition to minimum inhibitory concentrations when selecting antibiotics for otitis media 4.
• Amoxicillin at conventional or high doses remains an appropriate choice for first-line therapy, while second-line therapy should have demonstrated activity against penicillin-resistant S. pneumoniae and beta-lactamase-producing pathogens 4.

Clinical Efficacy of Antibiotics

• Amoxicillin/clavulanate has been shown to have superior bacteriologic and clinical efficacy compared to azithromycin in children with acute otitis media 5, 6.
• Large dosage amoxicillin/clavulanate has been found to be clinically and bacteriologically more effective than azithromycin in children with bacterial acute otitis media, including cases caused by penicillin-resistant S. pneumoniae and beta-lactamase-positive H. influenzae 6.