From the Guidelines
For a 61-year-old female with acute otitis media presenting with right-sided hearing loss and moderate otalgia, I strongly recommend initiating treatment with amoxicillin at a dosage of 80 to 90 mg per kg per day, as this has been shown to be effective against susceptible and intermediate resistant pneumococci 1. The choice of amoxicillin as first-line therapy is based on its efficacy, safety, and narrow microbiologic spectrum, making it an ideal option for treating AOM in adults 1. Key considerations in the management of this patient include:
- The optimal duration of therapy, which is uncertain, but typically ranges from 5-7 days
- The potential for penicillin allergy, in which case alternative antibiotics such as cefdinir, cefpodoxime, or cefuroxime may be considered 1
- The importance of pain management, which can be achieved with acetaminophen or ibuprofen as needed
- The need for the patient to avoid getting water in the ear during treatment and to return for reassessment if symptoms worsen or do not improve within 48-72 hours. It is also essential to note that the hearing loss is likely due to fluid buildup behind the eardrum, which should resolve as the infection clears, although complete resolution of hearing may take several weeks 1.
From the FDA Drug Label
For the 553 patients who were evaluated for clinical efficacy, the clinical success rate (i. e., cure plus improvement) at the Day 11 visit was 88% for azithromycin and 88% for the control agent. The combined clinical success rate (i.e., cure and improvement) of those patients with a baseline pathogen at the Day 11 visit was 88% for azithromycin vs. 100% for control; at the Day 30 visit, the clinical success rate was 82% for azithromycin vs. 80% for control. The clinical efficacy rates at the end of therapy visit (defined as 2 to 4 days after the completion of therapy) and at the follow-up visit (defined as 22 to 28 days post-completion of therapy) were comparable for the 2 treatment groups, with the following cure rates obtained for the evaluable patients: At end of therapy, 87% (n = 265) and 82% (n = 260) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively.
The treatment for a 61-year-old female with acute otitis media (AOM) presenting with right-sided hearing loss and moderate otalgia (ear pain) is amoxicillin-clavulanate or azithromycin.
- Amoxicillin-clavulanate is a suitable option, with clinical efficacy rates of 87% at the end of therapy and 67% at follow-up 2.
- Azithromycin is also a suitable option, with clinical success rates of 88% at Day 11 and 82% at Day 30 3. However, the FDA label does not provide specific guidance for a 61-year-old female patient, as the clinical trials were conducted in pediatric patients or patients with lower respiratory tract infections or complicated urinary tract infections. Therefore, the choice of treatment should be based on clinical judgment and consideration of the patient's individual needs and medical history.
From the Research
Treatment for Acute Otitis Media (AOM)
The treatment for a 61-year-old female with acute otitis media (AOM) presenting with right-sided hearing loss and moderate otalgia (ear pain) should begin with:
- Adequate analgesia to manage pain 4
- Antibiotic therapy, as the patient is an adult and the symptoms are moderate
Antibiotic Therapy
The recommended antibiotic for treating AOM in patients who are not allergic to penicillin is:
- High-dose amoxicillin (80 to 90 mg per kg per day) 4, 5, 6, 7
- If the patient has persistent symptoms despite 48 to 72 hours of antibiotic therapy, a second-line agent such as amoxicillin/clavulanate may be used 4, 5, 6, 7
Considerations for Treatment
When selecting an antibiotic, the physician should consider:
- In vitro activity, particularly against drug-resistant Streptococcus pneumoniae 6, 7
- Pharmacokinetics 6, 7
- Adverse events 6
- Palatability of the suspension 5
- Cost 8, 6
- The patient's age and medical history 8, 7