What are the diagnostic criteria and treatment options for Acute Otitis Media (AOM) in adults?

From the Guidelines

Acute otitis media (AOM) in adults should be treated with analgesics and antibiotics if symptoms are severe or persistent, with first-line antibiotic therapy being amoxicillin 80-90 mg/kg/day, as recommended by the American Academy of Pediatrics and American Academy of Family Physicians 1.

Treatment Approach

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• The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present, with amoxicillin being effective against susceptible and intermediate resistant pneumococci 1.
• If the patient is allergic to amoxicillin, alternatives include cefdinir, cefpodoxime, or cefuroxime, as recommended by the American Academy of Pediatrics and American Academy of Family Physicians 1.

Considerations

• The optimal duration of therapy for patients with AOM is uncertain, but treatment for 5-7 days is commonly recommended.
• Patients should avoid flying, smoking, and getting water in the affected ear to prevent complications.
• AOM in adults is less common than in children and often results from upper respiratory infections causing eustachian tube dysfunction, allowing bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to proliferate in the middle ear.
• Complications like hearing loss, tympanic membrane perforation, or mastoiditis require prompt ENT referral.

Recent Guidelines

• The American Academy of Pediatrics recommends initial observation for AOM in select children, but this approach may not be applicable to adults 1.
• The decision to treat with antibacterial agents should be based on the severity of symptoms and the risk of complications, with antibiotics halving the risk of mastoiditis after AOM 1.

From the FDA Drug Label

ACUTE BACTERIAL OTITIS MEDIA caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta‑lactamase producing strains) or Moraxella catarrhalis (including beta-lactamase producing strains). NOTE: In one study lower clinical cure rates were observed with a single dose of Ceftriaxone for Injection, USP compared to 10 days of oral therapy The Ceftriaxone for Injection, USP is indicated for the treatment of Acute Bacterial Otitis Media (AOM) in adults caused by susceptible organisms, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. However, the clinical cure rate with a single dose of Ceftriaxone may be lower compared to 10 days of oral therapy 2.

From the Research

Incidence of AOM in Adults

• The incidence of AOM in adults is relatively low, with a study finding an overall incidence of 5.3/1000 person-years 3.
• The incidence of AOM in adults is higher in atopic patients, with a rate of 7.3/1000 person-years 3.
• The incidence of AOM in adults declines with age, from 7.1/1000 person-years in patients aged 15-39 years to 2.7/1000 person-years in those aged 64 years and older 3.

Treatment of AOM in Adults

• Oral antibiotics, predominantly amoxicillin, are prescribed in 46% of AOM episodes in adults, while topical antibiotics are prescribed in 21% of episodes 3.
• There is limited research on the treatment of AOM in adults, with most studies focusing on pediatric populations.
• However, studies on pediatric populations suggest that amoxicillin is an effective treatment for AOM, and that once or twice daily doses may be as effective as three or four times daily doses 4, 5, 6.
• A short course of antibiotics (<4 days) may be effective for the treatment of AOM in children, with some studies suggesting that it is associated with a lower risk of adverse effects 7.

Management of AOM

• The management of AOM typically involves the use of antibiotics, with amoxicillin being a common first-line treatment 5, 6.
• The choice of antibiotic and duration of treatment may depend on various factors, including the severity of symptoms, patient age, and presence of underlying medical conditions.
• Tympanocentesis may be useful for identifying the causative pathogen in patients who have failed multiple courses of antibiotics 5.
• The pneumococcal conjugate vaccine may be beneficial for preventing recurrent AOM in certain populations, such as young children and those at high risk of complications 5.