What is the treatment for otitis media in adults?

Treatment of Otitis Media in Adults

For adults with otitis media, oral antibiotic therapy with amoxicillin-clavulanate, cefuroxime-axetil, or cefpodoxime-proxetil is the recommended first-line treatment. 1

Causative Organisms and Antibiotic Selection

The primary bacteria involved in adult otitis media are the same as those in children:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis (formerly Branhamella catarrhalis)

First-line Antibiotic Options:

• Amoxicillin-clavulanate: Preferred when no specific bacterial markers are available 1
• Cefuroxime-axetil: Good alternative with appropriate coverage 1
• Cefpodoxime-proxetil: Another effective option 1

Clinical Presentation-Based Selection:

• For otitis with purulent conjunctivitis (suggesting H. influenzae): Use cefixime, cefpodoxime-proxetil, amoxicillin-clavulanate, or cefuroxime-axetil 1
• For febrile painful otitis (suggesting pneumococcal infection): Use amoxicillin, cefuroxime-axetil, or cefpodoxime-proxetil 1

For Penicillin Allergy:

• Erythromycin-sulfafurazole is the recommended alternative 1

Treatment Duration

The recommended treatment duration for adults with otitis media is typically 5 days, which is shorter than the 8-10 days recommended for children under 2 years of age 1.

Monitoring Treatment Response

Treatment failure is defined as:

• Worsening of the patient's condition
• Persistence of symptoms for more than 48 hours after starting antibiotics
• Recurrence of functional and systemic signs with otoscopic signs of purulent AOM within 4 days of treatment discontinuation 1

If treatment fails, consider:

1. Collection of a bacteriological specimen
2. Changing antibiotic therapy based on the first agent used and bacteria isolated 1

Adjunctive Treatments

Pain management is essential in otitis media treatment:

• Acetaminophen or NSAIDs are recommended for immediate pain relief 2
• Pain typically improves within approximately 48 hours of starting appropriate treatment 2

Important Considerations

Diagnostic Accuracy

Proper diagnosis is crucial to avoid unnecessary antibiotic use. The incidence of otitis media in adults is approximately 5.3/1000 person-years, with higher rates in younger adults (15-39 years) and those with atopic conditions 3.

Antibiotic Resistance Concerns

The choice of antibiotics should consider the increasing prevalence of resistant bacteria:

• Beta-lactamase-producing H. influenzae and M. catarrhalis are increasingly common 4
• Penicillin-resistant S. pneumoniae is a growing concern 1

Avoiding Common Pitfalls

• Don't use neomycin-containing products as first-line therapy due to risk of sensitization 2
• Don't use cotton-tipped swabs in the ear canal as they can cause trauma and worsen infection 2
• Don't discontinue treatment prematurely even if symptoms improve 2
• Don't use systemic antibiotics for uncomplicated otitis externa (which requires topical treatment) 2

When to Consider Referral to Specialist

Consider referral to an otolaryngologist for:

• Treatment failure despite appropriate antibiotic therapy
• Recurrent episodes
• Complications such as hearing loss
• Chronic middle ear effusion persisting beyond 3 months 5

Remember that while otitis media is less common in adults than in children, the treatment approach follows similar principles, with appropriate adjustments for adult patients.