From the Guidelines
The treatment for Acute Otitis Media (AOM) in adults should be amoxicillin 80 to 90 mg per kg per day, as it is generally effective against susceptible and intermediate resistant pneumococci, and has a narrow microbiologic spectrum, as recommended by the AAP and AAFP guideline 1. When considering treatment options, it's essential to weigh the benefits and risks of each medication.
- Amoxicillin is recommended as first-line therapy for AOM due to its effectiveness, safety, and affordability, as well as its acceptable taste and narrow microbiologic spectrum 1.
- If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, alternative options include cefdinir, cefpodoxime, or cefuroxime, as suggested by the AAP and AAFP guideline 1.
- The optimal duration of therapy for patients with AOM is uncertain, but the goal is to provide sufficient treatment to resolve the infection while minimizing the risk of antibiotic resistance.
- Pain management and supportive care are also crucial components of AOM treatment, and may include the use of acetaminophen or ibuprofen for pain relief, as well as decongestants and warm compresses to alleviate ear pressure.
- It's worth noting that AOM in adults is relatively rare, and the bacteria involved are similar to those observed in children, with the therapeutic choices not differing significantly between the two populations, as stated in the French guidelines for systemic antibiotic treatment in upper and lower respiratory tract infections 1.
From the Research
Treatment for Acute Otitis Media (AOM) in Adults
- The treatment for AOM in adults typically involves the use of antibiotics, with amoxicillin being the first-line antibiotic recommended by most scientific societies 2, 3.
- A study published in 2021 found that oral antibiotics, predominantly amoxicillin, were prescribed in 46% of AOM episodes in adults, while topical antibiotics were prescribed in 21% of episodes 4.
- The use of paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief in AOM is also common, although the evidence for their effectiveness in adults is limited 5.
- There is no evidence to suggest that the treatment for AOM in adults differs significantly from that in children, although the incidence of AOM in adults is generally lower than in children 4.
- Amoxicillin-clavulanate is also considered an effective treatment option for AOM, and its efficacy has been compared to other antimicrobials or placebo in several studies 6.
Antibiotic Treatment
- Amoxicillin is the most commonly prescribed antibiotic for AOM in adults, and is effective against a range of bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2, 3.
- The use of amoxicillin-clavulanate is also effective in eradicating Streptococcus pneumoniae from the culture, and is considered a treatment of choice for children between 6 months and 12 years of age with AOM 6.
Pain Relief
- Paracetamol and NSAIDs are commonly used for pain relief in AOM, although the evidence for their effectiveness in adults is limited 5.
- A study published in 2016 found that both paracetamol and ibuprofen were more effective than placebo in relieving short-term ear pain in children with AOM, although the evidence was of low quality 5.