From the Guidelines
For an 83-year-old female with otitis media, I recommend amoxicillin as first-line treatment at a dose of 80 to 90 mg per kg per day, as suggested by the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guideline 1. When prescribing amoxicillin, it is essential to consider the patient's weight to determine the correct dosage.
- The choice of amoxicillin is based on its effectiveness against susceptible and intermediate resistant pneumococci, as well as its safety, affordability, and acceptable taste 1.
- If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, alternative options such as cefdinir, cefpodoxime, or cefuroxime can be considered 1.
- Given the patient's advanced age, it is crucial to monitor for potential side effects and interactions with other medications, as well as to assess for any hearing loss, vertigo, or balance issues that may increase fall risk.
- Pain management is also essential, and acetaminophen can be used as needed, while avoiding NSAIDs due to the increased risk of adverse effects in elderly patients.
- The optimal duration of therapy for patients with AOM is uncertain, but a typical course of 5-7 days is often recommended 1.
- Regular follow-up is necessary to ensure the patient's symptoms are improving and to address any concerns or complications that may arise.
From the FDA Drug Label
In a double-blind, controlled, randomized clinical study of acute otitis media in pediatric patients from 6 months to 12 years of age, azithromycin (10 mg/kg per day for 3 days) was compared to amoxicillin/clavulanate potassium (7:1) in divided doses q12h for 10 days For the 366 patients who were evaluated for clinical efficacy at the Day 12 visit, the clinical success rate (i.e., cure plus improvement) was 83% for azithromycin and 88% for the control agent.
The patient in question is an 83-year-old female, which is outside the age range of the pediatric patients in the study. No conclusion can be drawn from the provided drug labels regarding the treatment of an 83-year-old female with otitis media using azithromycin or amoxicillin-clavulanate. 2, 2, 3
From the Research
Treatment Options for Otitis Media
- High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) is the recommended treatment for acute otitis media, as stated in 4 and 5.
- For patients who are not allergic to penicillin, high-dose amoxicillin is the antibiotic of choice, according to 5.
- Alternative treatment options include amoxicillin/clavulanate, cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone, as mentioned in 4.
Considerations for Treatment
- The choice of antibiotic should be based on the patient's age, weight, and medical history, as well as the severity of the infection.
- It is essential to consider the potential for antibiotic resistance, as noted in 6.
- The treatment should be tailored to the individual patient's needs, taking into account factors such as the presence of beta-lactamase-producing pathogens, as discussed in 4.
Comparison of Antibiotics
- Amoxicillin/clavulanate has been shown to be more effective than azithromycin in eradicating bacterial pathogens from middle ear fluid, according to 7.
- Trimethoprim-sulfamethoxazole has been found to be more effective than amoxicillin-clavulanate in treating acute otitis media, as reported in 8.
Special Considerations for Elderly Patients
- There is limited information available on the treatment of otitis media in elderly patients, particularly those over 80 years old.
- However, the same treatment principles apply, and the choice of antibiotic should be based on the patient's individual needs and medical history, as well as the severity of the infection, as discussed in 4 and 5.