From the Guidelines
For a 22-year-old male with chronic otitis media who last took Augmentin over six months ago, amoxicillin-clavulanate (Augmentin) remains a recommended first-line antibiotic, as the risk of resistance development is lower due to the time elapsed since the last treatment 1. The typical adult dosage is 875 mg amoxicillin/125 mg clavulanate twice daily for 10-14 days.
Key Considerations
- Since the previous course was over six months ago, resistance development to this antibiotic is less likely.
- Alternative options include cefuroxime 500 mg twice daily for 10 days or, if penicillin-allergic, trimethoprim-sulfamethoxazole or a fluoroquinolone like ciprofloxacin with clindamycin.
- It's essential to complete the full course of antibiotics even if symptoms improve earlier.
- The patient should follow up if symptoms don't improve within 48-72 hours, as this might indicate resistant bacteria requiring culture-directed therapy.
Rationale
Chronic otitis media often involves mixed bacterial infections including anaerobes and gram-negative organisms, which amoxicillin-clavulanate covers well due to its broad spectrum and beta-lactamase inhibition properties.
Additional Guidance
- When amoxicillin (clavulanate) is selected for patients at risk for infection with penicillin-resistant S pneumoniae or DRSP, the high-dose regimen (ie, 4 g/250 mg) should be used 1.
- Failure to respond to antimicrobial therapy after 72 hours should prompt either a switch to alternate antimicrobial therapy or reevaluation of the patient.
From the FDA Drug Label
14.2 Acute Bacterial Otitis Media and Diarrhea in Pediatric Patients
One U.S./Canadian clinical trial was conducted which compared 45/6. 4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media.
The FDA drug label does not answer the question.
From the Research
Recommended Antibiotic for Chronic Otitis Media
The recommended antibiotic for an adult male with chronic otitis media, last treated with Augmentin (amoxicillin/clavulanate) over six months ago, is not directly stated in the provided studies. However, the following information can be gathered:
- According to 2, Pseudomonas aeruginosa is usually treated with topical ciprofloxacin, but resistance to ciprofloxacin has been reported.
- 3 discusses the use of amoxicillin/clavulanic acid in pediatric patients with acute otitis media, but does not provide information on adult patients with chronic otitis media.
- 4 suggests that sensitive antibiotics chosen from results of bacterial culture and drug sensitivity test are useful in reducing the complication of infection after surgery.
- 5 analyzes the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media, and finds that MSSA, MRSA, and Pseudomonas aeruginosa are the main pathogenic bacteria.
- 6 evaluates the effect of antibiotic/steroid ear drops in adults with active chronic otitis media, and finds that 52% of ears receiving active therapy became otoscopically inactive.
Possible Treatment Options
Based on the provided studies, possible treatment options for an adult male with chronic otitis media may include:
- Topical ciprofloxacin, although resistance has been reported 2
- Amoxicillin/clavulanic acid, although its effectiveness in adult patients with chronic otitis media is not established 3
- Sensitive antibiotics chosen from results of bacterial culture and drug sensitivity test 4
- Antibiotics effective against MSSA, MRSA, and Pseudomonas aeruginosa, such as vancomycin, linezolid, and meropenem 5
- Antibiotic/steroid ear drops, which have been shown to be effective in some cases 6
Key Considerations
When choosing a treatment option, the following factors should be considered: