What is the appropriate dosing of Amoxicillin (amoxicillin) for adults with otitis media (ear infection)?

From the Guidelines

For adults with an ear infection, the recommended amoxicillin dosage is 1.5-4 g/day, with the total daily dose varying based on disease severity and risk factors for resistant pathogens. The dosage can range from 1.5 g/day for mild disease with no recent antimicrobial use to 4 g/day for moderate disease or patients with risk factors for infection with a resistant pathogen 1. Key factors to consider when determining the dosage include the severity of the disease, recent antimicrobial use, and the presence of risk factors for resistant pathogens. Some important points to note:

• The total daily dose of amoxicillin can vary from 1.5 to 4 g/day 1
• Lower daily doses (1.5 g/day) are more appropriate in mild disease in patients with no risk factors for infection with a resistant pathogen 1
• Higher daily doses (4 g/day) may be advantageous in areas with a high prevalence of penicillin-resistant S pneumoniae or DRSP, for patients with moderate disease, for patients who may need better H influenzae coverage or for patients with risk factors for infection with a resistant pathogen 1. It is essential to take the full course of antibiotics as prescribed, even if symptoms improve before completion, and to stay hydrated throughout the treatment period. Additionally, patients should be aware of potential side effects, such as severe diarrhea, and contact their healthcare provider if symptoms worsen or do not improve after 3 days. If a patient has a penicillin allergy, alternative antibiotics like azithromycin or clarithromycin may be necessary 1.

From the FDA Drug Label

In Adults, 750 to 1750 mg/day in divided doses every 8 to 12 hours

• The recommended dosage of amoxicillin for adults with an ear infection is 750 to 1750 mg/day in divided doses every 8 to 12 hours 2.
• The dosing regimen may vary depending on the severity of the infection and the patient's response to treatment.
• It is essential to follow the prescribed dosage and administration instructions to ensure effective treatment and minimize the risk of adverse reactions.

From the Research

Amoxicillin Dosing for Adults with Ear Infection

• The provided studies do not directly address amoxicillin dosing for adults with ear infections. However, some studies compare the effectiveness of different antibiotics, including amoxicillin, in treating ear infections in children and adults 3, 4, 5, 6.
• One study compared azithromycin, amoxicillin/clavulanic acid, and cefaclor in treating acute ear, nose, and throat infections in adults, but it did not provide specific dosing information for amoxicillin in adults with ear infections 3.
• Another study compared once or twice daily doses of amoxicillin with or without clavulanate to three or four daily doses in children with acute otitis media, but it did not address adult dosing 4.
• A systematic review and meta-analysis compared the efficacy and safety of azithromycin and amoxicillin/clavulanate in treating otitis media in children, but it did not provide information on adult dosing 5.
• A population-based study compared the effectiveness of amoxicillin, azithromycin, cefprozil, and clarithromycin in treating acute otitis media in children, but it did not address adult dosing 6.

Relevant Findings

• Azithromycin was found to be more effective than amoxicillin/clavulanic acid in treating acute ear, nose, and throat infections in adults, with a faster clinical improvement and more rapid normalization of inflammatory markers 3.
• Once or twice daily doses of amoxicillin with or without clavulanate were found to be comparable to three or four daily doses in treating acute otitis media in children 4.
• Azithromycin was found to have anti-inflammatory effects in a guinea pig model of otitis media with effusion, and its use is recommended due to its antibacterial and anti-inflammatory efficacy 7.
• Azithromycin was found to be comparable to amoxicillin/clavulanate in treating otitis media in children, with a lower risk of adverse events 5.
• Azithromycin was found to have a lower risk of failure in treating acute otitis media in children compared to amoxicillin, but it had a higher risk of failure during the first few days of treatment 6.