What is the recommended dosing for amoxicillin (amoxicillin) in an adult with otitis media?

From the Guidelines

For adults with otitis media, the recommended dosage of amoxicillin is not explicitly stated in the provided evidence, but based on the available information, a dosage of 80 to 90 mg per kg per day can be extrapolated for pediatric use, however, for adults, a common dosage is 500 mg orally three times daily or 875 mg orally twice daily for 5-7 days, as this is a common practice in clinical settings 1.

Key Considerations

• The choice of amoxicillin as first-line therapy is based on its effectiveness against susceptible and intermediate resistant pneumococci, as well as its safety, affordability, and narrow microbiologic spectrum 1.
• The optimal duration of therapy for patients with AOM is uncertain, but a course of 5-7 days is commonly recommended.
• Patients should be advised to complete the full course of antibiotics even if symptoms improve before completion.
• Taking amoxicillin with food can help reduce gastrointestinal side effects.
• Patients should be advised to contact their healthcare provider if symptoms worsen or do not improve after 3 days of treatment.

Important Factors

• Amoxicillin is effective for otitis media because it targets the most common bacterial pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
• The higher dosing regimen helps overcome intermediate resistance that may be present in some bacterial strains.
• If there is concern for drug-resistant Streptococcus pneumoniae or if the patient has failed initial therapy, amoxicillin-clavulanate (875 mg/125 mg twice daily) may be used instead, although this is not explicitly stated in the provided evidence for adult use.

From the Research

Dosing for Amoxicillin in Adults with Otitis Media

• The recommended dosing for amoxicillin in adults with otitis media is not explicitly stated in the provided studies, as they primarily focus on pediatric populations.
• However, one study 2 mentions that high-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) remains the drug of choice for treatment of acute otitis media, but this is in the context of pediatric treatment.
• Another study 3 suggests that amoxicillin at conventional or high doses (80-90 mg/kg/day) remains an appropriate choice for first-line therapy for AOM, but again, this is in the context of pediatric treatment.
• There is no direct evidence provided for the recommended dosing of amoxicillin in adults with otitis media.

Considerations for Treatment

• The treatment of otitis media should consider the causative pathogen and the potential for antibiotic resistance 2, 3.
• High-dose amoxicillin/clavulanate (90/6.4 mg/kg/d) is recommended for persistent or recurrent acute otitis media 2.
• The frequency of dosing (once or twice daily) may not significantly impact the effectiveness of amoxicillin treatment for AOM 4.

Limitations

• The provided studies primarily focus on pediatric populations, and there is limited information available on the recommended dosing for amoxicillin in adults with otitis media.
• Further research is needed to determine the optimal dosing regimen for amoxicillin in adults with otitis media.