From the Guidelines
For patients with otitis media (OM) who also have gastritis, amoxicillin can still be used as first-line treatment, but should be taken with food to minimize gastric irritation. The recommended dosage is typically 80 to 90 mg per kg per day, as suggested by the American Academy of Pediatrics and the American Academy of Family Physicians 1. To reduce gastric irritation, consider using amoxicillin with a proton pump inhibitor or an H2 blocker. Some key points to consider when prescribing amoxicillin for OM in patients with gastritis include:
- Taking the medication with a meal or snack to improve tolerability
- Using the recommended dosage to ensure effectiveness against susceptible and intermediate resistant pneumococci
- Considering alternative antibiotics if gastritis symptoms worsen despite these measures, though they may have slightly lower efficacy against common OM pathogens
- Maintaining adequate hydration to support overall health and reduce the risk of complications. It's essential to weigh the benefits and risks of using amoxicillin in patients with gastritis, as the medication is generally effective and safe when used in sufficient doses, as noted in the guideline on diagnosis and management of acute otitis media 1.
From the Research
Treatment of Otitis Media with Amoxicillin in Patients with Gastritis
- Amoxicillin is a commonly used antibiotic for the treatment of otitis media (OM) in children and adults 2, 3.
- However, in patients with gastritis, the use of amoxicillin may be problematic due to the potential for gastrointestinal side effects.
- A study published in 1998 found that a combination of omeprazole, clarithromycin, and amoxicillin was effective in eradicating Helicobacter pylori in patients with peptic ulcer and symptomatic chronic gastritis 4.
- This suggests that amoxicillin can be used in patients with gastritis, but it may be necessary to add other medications, such as omeprazole, to reduce the risk of gastrointestinal side effects.
- The American Academy of Pediatrics recommends the use of high-dose amoxicillin for the treatment of acute uncomplicated OM, but this may not be necessary for patients with gastritis 5.
- In patients with a reported penicillin allergy, alternative antibiotics such as trimethoprim/sulfamethoxazole may be used to treat OM 6.
- However, the reliability of reported penicillin allergies is uncertain, and amoxicillin may still be a viable option for patients with gastritis and OM 6.
Considerations for Treatment
- The choice of antibiotic for OM in patients with gastritis should be based on the severity of the infection, the patient's medical history, and the potential for gastrointestinal side effects.
- The use of amoxicillin in patients with gastritis should be carefully monitored, and alternative antibiotics should be considered if gastrointestinal side effects occur.
- The addition of medications such as omeprazole may be necessary to reduce the risk of gastrointestinal side effects in patients with gastritis who are treated with amoxicillin.