From the Guidelines
The recommended treatment for adult acute otitis media is amoxicillin as the first-line treatment at a dose of 80 to 90 mg per kg per day, as it is generally effective against susceptible and intermediate resistant pneumococci, and is safe, inexpensive, and has an acceptable taste and narrow microbiologic spectrum 1.
Treatment Approach
The treatment approach for adult acute otitis media typically begins with pain management using analgesics such as acetaminophen or ibuprofen. For mild cases without severe symptoms, a watchful waiting approach for 48-72 hours may be appropriate.
Antibiotic Therapy
If symptoms are severe or persist, antibiotic therapy is indicated, with amoxicillin as the first-line treatment.
- The dosage of amoxicillin should be 80 to 90 mg per kg per day, as recommended by the AAP and AAFP guideline on diagnosis and management of acute otitis media 1.
- For patients with penicillin allergy, alternatives include cefdinir, cefpodoxime, or cefuroxime, as these medications are clinically effective and have a narrow microbiologic spectrum 1.
- In cases of treatment failure or suspected resistant bacteria, amoxicillin-clavulanate may be considered, as it provides broader coverage against resistant organisms 1.
Additional Considerations
- Decongestants or antihistamines are generally not recommended as they provide little benefit.
- Patients should be advised to complete the full course of antibiotics even if symptoms improve quickly, and to follow up if symptoms worsen or don't improve within 48-72 hours of starting antibiotics.
- Antibiotics are prescribed because acute otitis media is commonly caused by bacterial pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which often require antimicrobial therapy to resolve the infection and prevent complications.
From the Research
Adult Acute Otitis Media Treatment
The recommended treatment for adult acute otitis media includes:
- High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) as the first-line treatment 2
- Alternative options for persistent or recurrent acute otitis media:
- High-dose amoxicillin/clavulanate (90/6.4 mg/kg/d)
- Cefdinir
- Cefprozil
- Cefpodoxime
- Cefuroxime
- Ceftriaxone 2
- Amoxicillin/clavulanic acid is effective against the main pathogens associated with acute otitis media, including penicillin-susceptible and -intermediate strains of Streptococcus pneumoniae, and beta-lactamase producing strains of Haemophilus influenzae and Moraxella catarrhalis 3
Considerations for Treatment
- The choice of antibiotic should be based on the severity of the infection, patient age, and presence of underlying medical conditions 4
- Twice-daily antibiotics, such as trimethoprim-sulfamethoxazole, may be effective in the treatment of acute otitis media, but may have a higher rate of gastrointestinal side effects compared to amoxicillin-clavulanate 5
- Variations in antibiotic prescribing rates and choices have been observed across different countries, with narrow-spectrum penicillin being commonly prescribed in Nordic countries and broad-spectrum penicillins being prescribed in other countries 6