From the FDA Drug Label
1.2 Otitis Media Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with otitis media caused by susceptible isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes.
The recommended antibiotic for a 22-year-old adult male with chronic otitis media is Cefixime. However, it's essential to note that the efficacy of cefixime for otitis media caused by Streptococcus pneumoniae is approximately 10% lower than the comparator, as stated in the clinical studies 1" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(1).
- Key points:
- Cefixime is indicated for otitis media in adults and pediatric patients six months of age or older.
- The recommended dose of cefixime for adults is 400 mg daily 1" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(1).
From the Research
For chronic otitis media in a 22-year-old male who previously used Augmentin over six months ago, I recommend amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 10 days as the first-line treatment. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin-clavulanate is effective against common pathogens associated with chronic otitis media, including beta-lactamase producing organisms like Haemophilus influenzae and Moraxella catarrhalis, as well as Streptococcus pneumoniae 2.
Key Considerations
- The previous course of Augmentin was more than six months ago, which reduces the likelihood of resistance development.
- If the patient has a penicillin allergy, alternative options include levofloxacin 750 mg daily for 10 days or clarithromycin 500 mg twice daily for 10 days.
- Completing the full course of antibiotics is crucial, even if symptoms improve earlier.
- The patient should keep the ear dry during treatment and follow up if symptoms don't improve within 48-72 hours, as this might indicate resistant bacteria requiring culture-directed therapy.
Pathogen Coverage
- Amoxicillin-clavulanate provides broad-spectrum coverage against common pathogens associated with chronic otitis media, including:
- Beta-lactamase producing organisms like Haemophilus influenzae and Moraxella catarrhalis
- Streptococcus pneumoniae
- Other pathogens like Staphylococcus aureus and Pseudomonas aeruginosa
Treatment Duration and Follow-up
- The recommended treatment duration is 10 days.
- Follow-up is essential to monitor the patient's response to treatment and to adjust the treatment plan if necessary 3.