From the Research
For adults with acute otitis media (AOM), the recommended dose of amoxicillin is 500 mg three times daily or 875 mg twice daily for 5-7 days, as this higher dosage is necessary to overcome potential resistant strains of Streptococcus pneumoniae, which is a common causative organism 1.
Key Considerations
- The dosage is based on the most recent and highest quality study, which compared the effectiveness of one or two daily doses with three or four daily doses of amoxicillin, with or without clavulanate, for the treatment of AOM in children, and found that once or twice daily doses were comparable to three doses for the treatment of AOM 1.
- If the patient has risk factors for resistant organisms (recent antibiotic use, treatment failure, or severe symptoms), amoxicillin-clavulanate may be preferred, dosed at 875/125 mg twice daily for 5-7 days.
- Patients with penicillin allergy can be treated with alternatives such as cefuroxime 500 mg twice daily or, in case of severe penicillin allergy, azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days.
Additional Recommendations
- It's essential to provide adequate pain management with acetaminophen or ibuprofen while on antibiotics.
- If symptoms don't improve within 48-72 hours or worsen at any point, the patient should seek follow-up care as this may indicate treatment failure or complications requiring a change in therapy.
Evidence Summary
- A study published in 2013 found that once or twice daily doses of amoxicillin, with or without clavulanate, were comparable to three doses for the treatment of AOM 1.
- Another study published in 2004 found that high-dose amoxicillin did not result in a greater incidence of adverse effects than standard-dose amoxicillin, and had neither benefit nor detriment compared with standard-dose for AOM in children at low risk for infection with antibiotic-resistant bacteria 2.