From the Guidelines
The recommended treatment for otitis media in adults typically begins with antibiotics, with amoxicillin-clavulanate being a suitable option, as noted in a study from 2003 1.
Treatment Options
- For patients with penicillin allergies, alternatives may be considered, but the most recent and highest quality study on otitis media treatment, from 2017, emphasizes the importance of accurate diagnosis and optimal management of ear pain 1.
- Pain management is essential and can include acetaminophen or ibuprofen, with decongestants like pseudoephedrine potentially helping to relieve ear pressure.
- The choice of antibiotic should be based on the most recent guidelines, which suggest that amoxicillin-clavulanate is an appropriate choice for adults with otitis media, as supported by a 2004 study on antimicrobial treatment guidelines for acute bacterial rhinosinusitis 1.
Key Considerations
- Patients should complete the full course of antibiotics even if symptoms improve, and follow up if symptoms worsen or don't improve within 48-72 hours of treatment.
- For severe cases or those unresponsive to oral antibiotics, referral to an ENT specialist may be necessary for tympanocentesis or more aggressive treatment.
- The most recent study from 2017 highlights the importance of reducing the burden of otitis media and making decisions based on the best available evidence 1.
From the FDA Drug Label
CLINICAL STUDIES SECTION Pediatric Patients ... Acute Otitis Media Safety and efficacy using azithromycin 30 mg/kg given over 5 days ...
The FDA drug label does not answer the question.
From the Research
Recommended Treatment for Otitis Media in Adults
- The management of otitis media with effusion in adults is an area that requires a rethink, with ventilation tubes being associated with disappointing outcomes and significant complications 2.
- Alternatives to ventilation tubes, such as balloon dilatation of the Eustachian tube, intratympanic steroid therapy, and cortical mastoidectomy, appear to be possible options for the management of otitis media with effusion in adults 2.
- For cases not associated with nasopharyngeal carcinoma, intratympanic steroid therapy appears to be a promising option for the management of otitis media with effusion in adults 2.
- Acute otitis media is usually a complication of eustachian tube dysfunction that occurs during a viral upper respiratory tract infection, and management should begin with adequate analgesia 3, 4.
- High-dose amoxicillin is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin, although the effectiveness of antibiotics in adults is not well established 3, 4.
Analgesia and Antibiotic Therapy
- Adequate analgesia should be prescribed in all cases of acute otitis media 3, 4.
- Antibiotic therapy can be deferred in children two years or older with mild symptoms, but the effectiveness of this approach in adults is not well established 3, 4.
- Amoxicillin-clavulanate and trimethoprim-sulfamethoxazole are alternative antibiotic options for the treatment of acute otitis media, although their effectiveness in adults is not well established 5.
Limitations of Current Evidence
- There is limited evidence on the effectiveness of paracetamol or NSAIDs, alone or combined, in relieving pain in adults with acute otitis media 6.
- Further research is needed to provide insights into the role of ibuprofen as adjunct to paracetamol, and other analgesics such as anaesthetic eardrops, for adults with acute otitis media 6.