What is the recommended dose of Augmentin (amoxicillin/clavulanate) for acute otitis media in a 30-year-old female?

Dosing Augmentin for Acute Otitis Media in a 30-Year-Old Female

For acute otitis media in a 30-year-old female, the recommended dose of Augmentin (amoxicillin-clavulanate) is 875 mg/125 mg twice daily for 5-7 days. This dosing provides optimal coverage against the common pathogens causing acute otitis media while balancing efficacy and side effect profile.

Antibiotic Selection Rationale

Amoxicillin-clavulanate is an appropriate first-line choice for adult acute otitis media for several reasons:

• It provides coverage against the three main pathogens associated with acute otitis media:

  • Streptococcus pneumoniae (including penicillin-intermediate strains)
  • Haemophilus influenzae (including β-lactamase producing strains)
  • Moraxella catarrhalis

• The clavulanate component inhibits β-lactamase enzymes, addressing resistance concerns that would make amoxicillin alone potentially ineffective 1, 2

Dosing Considerations

The adult dosing of Augmentin for acute otitis media follows these principles:

• Standard adult dose: 875 mg/125 mg twice daily
• Duration: 5-7 days is typically sufficient for uncomplicated cases in adults
• The twice-daily formulation improves compliance compared to three-times-daily regimens 3

Risk Factors for Resistant Pathogens

Consider using a higher dose or alternative antibiotic if the patient has risk factors for resistant pathogens:

• Recent antibiotic use (within past 30 days)
• Treatment failure with amoxicillin alone
• Concurrent conjunctivitis (suggests H. influenzae infection)
• Severe symptoms or complications 1

Alternative Options for Penicillin Allergy

If the patient has a penicillin allergy, alternative treatments include:

• For non-Type I allergies (e.g., rash):

  • Cefdinir 300 mg twice daily
  • Cefuroxime 500 mg twice daily
  • Cefpodoxime 200 mg twice daily

• For Type I allergies (anaphylaxis):

  • Respiratory fluoroquinolones (e.g., levofloxacin 750 mg daily)
  • Clindamycin 300-450 mg three times daily (if concerned primarily about S. pneumoniae) 4, 1

Treatment Failure Management

If the patient fails to respond to initial therapy after 48-72 hours:

1. Reevaluate the diagnosis
2. Consider switching to a different antibiotic class
3. Consider referral to an otolaryngologist if symptoms persist or worsen 4, 1

Monitoring and Follow-up

• Assess clinical response within 48-72 hours
• Complete the full course of antibiotics even if symptoms improve
• Watch for common side effects: diarrhea, nausea, vomiting, rash
• Consider probiotics to reduce risk of antibiotic-associated diarrhea

The twice-daily formulation of Augmentin has been shown to have equivalent efficacy to the three-times-daily regimen with potentially better compliance and fewer gastrointestinal side effects 3.