What is the recommended dose and frequency of amoxicillin (Amoxicillin) for an adult with acute otitis media (AOM)?

From the Guidelines

The recommended dose of amoxicillin for adult acute otitis media (AOM) is 500 mg taken orally three times daily (every 8 hours) for 5-7 days, as this dose is effective against common AOM bacterial pathogens and has a narrow microbiologic spectrum 1.

Key Considerations

• The dosage of amoxicillin should be based on the severity of the infection and the presence of antibiotic resistance in the area.
• For more severe infections or in areas with high antibiotic resistance, a higher dose of 875 mg twice daily (every 12 hours) may be prescribed.
• Amoxicillin should be taken with or without food, though taking it with food may help reduce stomach upset.
• It's essential to complete the full course of antibiotics even if symptoms improve before finishing the medication.

Alternative Treatments

• If the patient is allergic to amoxicillin, alternative treatments such as cefdinir, cefpodoxime, or cefuroxime may be prescribed 1.
• The choice of alternative treatment should be based on the severity of the allergy and the presence of other medical conditions.

Monitoring and Follow-up

• If symptoms don't improve within 48-72 hours, or if they worsen, medical reassessment is necessary as a different antibiotic may be needed.
• Patients with penicillin allergies should not take amoxicillin and should inform their healthcare provider to receive an alternative antibiotic.

Mechanism of Action

• Amoxicillin works by inhibiting bacterial cell wall synthesis, causing bacterial cell death.
• It's effective against many common bacteria that cause ear infections, including Streptococcus pneumoniae, which is the most common bacterial cause of AOM 1.

From the FDA Drug Label

The usual adult dose is one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 250 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours.

The recommended dose of amoxicillin for an adult with AOM is:

• 500 mg/125 mg every 12 hours
• 250 mg/125 mg every 8 hours
• For more severe infections, 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 2

From the Research

Adult AOM Amoxicillin Dose and Frequency

• The recommended dose and frequency of amoxicillin for adult acute otitis media (AOM) is not explicitly stated in the provided studies, as they primarily focus on pediatric populations 3, 4, 5, 6, 7.
• However, the studies suggest that high-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) is effective for treating AOM in children, and this dosage may be extrapolated to adults 5, 7.
• The frequency of amoxicillin administration is typically twice daily, as mentioned in the study by 5.
• It is essential to note that the treatment of AOM in adults may differ from that in children, and the dosage and frequency of amoxicillin may need to be adjusted based on individual patient factors, such as renal function and severity of infection.
• The American Academy of Family Physicians and other medical organizations may provide guidelines for the treatment of AOM in adults, including recommended dosages and frequencies of amoxicillin, but these are not cited in the provided studies.