Recommended Dosage of Augmentin for Otitis Media in Adults
For adults with acute otitis media, amoxicillin-clavulanate (Augmentin) should be administered at a dose of 875 mg/125 mg twice daily for 5-7 days. 1
Evidence-Based Rationale
The most recent guidelines from the WHO's Essential Medicines Expert Committee (2024) recommend amoxicillin-clavulanate as the second-choice antibiotic for acute otitis media, with amoxicillin being the first choice 1. For adults, the standard formulation of 875 mg/125 mg twice daily provides adequate coverage against the common pathogens involved in otitis media.
Pathogen Coverage
Amoxicillin-clavulanate provides coverage against:
- Streptococcus pneumoniae (including penicillin-intermediate strains)
- Beta-lactamase producing Haemophilus influenzae
- Moraxella catarrhalis
The addition of clavulanic acid to amoxicillin extends coverage to beta-lactamase producing organisms, which are common causes of treatment failure with amoxicillin alone 2, 3.
Treatment Duration
While children typically require 10-14 days of therapy 1, adults with uncomplicated otitis media can be effectively treated with a shorter 5-7 day course 1. The Infectious Diseases Society of America (IDSA) guidelines support this shorter duration for adults with uncomplicated infections 1.
Alternative Dosing Considerations
- High-dose formulation: In areas with high prevalence of penicillin-resistant S. pneumoniae, a higher dose formulation (2000 mg/125 mg twice daily) may be considered 2.
- Twice-daily dosing: The twice-daily regimen is preferred over three-times-daily dosing as it shows equivalent efficacy with better compliance and potentially fewer gastrointestinal side effects 4.
Treatment Failure Management
If symptoms worsen or fail to improve after 48-72 hours of treatment:
- Reassess the diagnosis to confirm otitis media and exclude other causes
- Consider changing to an alternative antibiotic such as a respiratory fluoroquinolone or cephalosporin (cefdinir or cefuroxime) 1, 5
Common Side Effects and Management
Gastrointestinal disturbances are the most common adverse effects:
- Diarrhea (occurs in approximately 7-11% of patients) 4
- Nausea
- Abdominal discomfort
Taking the medication with food can help reduce GI irritation. If severe diarrhea develops, especially if bloody, the patient should seek immediate medical attention 5.
Special Considerations
- Penicillin allergy: For patients with non-type I hypersensitivity reactions to penicillin, cefdinir, cefpodoxime, or cefuroxime can be used as alternatives 1.
- Renal impairment: Dosage adjustment may be necessary in patients with severe renal dysfunction.
By following these evidence-based recommendations, clinicians can effectively treat adult patients with acute otitis media while minimizing the risk of treatment failure and antibiotic resistance.