What is the treatment for otitis media in an adult with an allergy to amoxicillin (amoxicillin)?

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Last updated: March 17, 2025 • View editorial policy

From the Guidelines

For adults with otitis media who have an amoxicillin allergy, the recommended treatment is cefdinir 300 mg twice daily for 5-7 days or cefuroxime 500 mg twice daily for 5-7 days, as these antibiotics are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 1. The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present. According to the American Academy of Pediatrics and the American Academy of Family Physicians, cefdinir, cefpodoxime, or cefuroxime can be prescribed for patients allergic to amoxicillin, as long as the allergic reaction is not a type I hypersensitivity reaction 2. Some key points to consider when treating otitis media in adults with an amoxicillin allergy include:

  • The optimal duration of therapy is uncertain, but treatment for 5-7 days is commonly recommended 2.
  • Symptomatic treatment with analgesics like acetaminophen or ibuprofen is also important for pain management.
  • If symptoms don't improve within 48-72 hours of starting antibiotics, or if they worsen at any point, the patient should seek follow-up care as this may indicate treatment failure or complications requiring different management. It's worth noting that the risk of cross-reactivity between penicillins and cephalosporins is lower than historically reported, and cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 1.

From the FDA Drug Label

CLINICAL STUDIES SECTION Pediatric Patients ... Acute Otitis MediaSafety and efficacy using azithromycin 30 mg/kg given over 5 days

Protocol 1 In a double-blind, controlled clinical study of acute otitis media performed in the United States, azithromycin (10 mg/kg on Day 1 followed by 5 mg/kg on Days 2 to 5) was compared to amoxicillin/clavulanate potassium (4:1).

Protocol 2 In a non-comparative clinical and microbiologic trial performed in the United States, where significant rates of beta-lactamase producing organisms (35%) were found, 131 patients were evaluable for clinical efficacy.

Protocol 3 In another controlled comparative clinical and microbiologic study of otitis media performed in the United States, azithromycin was compared to amoxicillin/clavulanate potassium (4:1).

The treatment for otitis media in an adult with an allergy to amoxicillin is azithromycin.

  • The dosage for adults is not specified in the provided text, but the studies suggest that azithromycin can be effective in treating otitis media.
  • The clinical success rate of azithromycin in treating otitis media is around 70-88% in the studies provided 3.
  • Side effects of azithromycin include diarrhea, vomiting, and abdominal pain, but the incidence of treatment-related adverse events is relatively low, around 9%.

From the Research

Treatment Options for Otitis Media in Adults with Amoxicillin Allergy

  • For adults with an allergy to amoxicillin, alternative antibiotics can be used to treat otitis media, as high-dose amoxicillin is typically the first line of treatment 4.
  • Other options include cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone, which are effective against Streptococcus pneumoniae and have good beta-lactamase stability 4.
  • Macrolide antibiotics like clarithromycin can also be considered, as they have been shown to be effective in treating acute otitis media in children 5.
  • Azithromycin is another option, which has been compared to amoxicillin in the prevention of recurrent acute otitis media, showing similar efficacy 6.
  • Trimethoprim/sulfamethoxazole (TMP/SMX) can also be used as an alternative to amoxicillin in patients with a reported penicillin allergy 7.

Key Considerations

  • The choice of antibiotic should be based on the severity of the infection, the patient's medical history, and the likelihood of antibiotic resistance 4.
  • It is essential to note that reported penicillin allergies may be unreliable, and further evaluation may be necessary to determine the best course of treatment 7.
  • The efficacy and safety of different antibiotics should be considered, as well as their potential side effects and interactions with other medications 5, 8, 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.