From the Guidelines
The treatment for Acute Otitis Media (AOM) in adults should be amoxicillin at a dosage of 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 1. When considering treatment options for AOM in adults, it's essential to weigh the benefits and risks of antibacterial agents.
- The choice of first-line treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present.
- Amoxicillin is recommended as first-line therapy for AOM because it is safe, inexpensive, and has an acceptable taste.
- If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, alternative antibiotics such as cefdinir, cefpodoxime, or cefuroxime can be prescribed 1. Key considerations in treating AOM in adults include:
- The optimal duration of therapy for patients with AOM is uncertain, but completing the full antibiotic course is crucial even if symptoms improve quickly.
- Pain management with acetaminophen or ibuprofen can be used as needed to alleviate discomfort.
- Decongestants like pseudoephedrine can help relieve ear pressure. It's crucial to note that antibiotics are effective because they target the common bacterial causes of AOM, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- If symptoms worsen or don't improve within 48-72 hours of treatment, patients should seek follow-up care as complications like mastoiditis or hearing loss can develop if AOM is inadequately treated.
From the Research
Treatment Options for Acute Otitis Media (AOM) in Adults
- The first-line treatment for AOM in adults is high-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) 2, 3.
- For persistent or recurrent AOM, guidelines recommend high-dose amoxicillin/clavulanate (90/6.4 mg/kg/d), cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone 2, 3.
- The choice of antibiotic should target Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis, as these bacteria are most often isolated in AOM 3.
- Factors to consider when selecting an antibiotic include in vitro activity, pharmacokinetics, adverse events, palatability of the suspension, and cost 4.
- The duration of antibiotic treatment is typically 8-10 days, depending on the severity of the infection and the presence of spontaneous perforation 5.
Considerations for Antibiotic Resistance
- Increasing antimicrobial resistance is a concern in the treatment of AOM, and guidelines recommend considering the local resistance patterns when selecting an antibiotic 2, 3.
- The use of amoxicillin/clavulanate or a cephalosporin with good activity against S pneumoniae and good beta-lactamase stability may be necessary to overcome resistance 2.
- A bacteriological study of the effusion may be necessary to determine the appropriate antibiotic to use in cases of treatment failure 5.