From the Guidelines
Adult otitis media treatment should prioritize amoxicillin as the first-line antibiotic, prescribed at a dosage of 80 to 90 mg per kg per day, as recommended by the American Academy of Pediatrics and American Academy of Family Physicians 1. For acute otitis media in adults, this translates to approximately 500 mg three times daily for 5-7 days. If the patient has penicillin allergy, alternatives include cefdinir, cefpodoxime, or cefuroxime, as suggested by the same guidelines 1. Pain relief can be managed with acetaminophen (650 mg every 6 hours) or ibuprofen (400-600 mg every 6-8 hours), and decongestants like pseudoephedrine (60 mg every 4-6 hours) may help with eustachian tube function. For otitis media with effusion, a watchful waiting approach is often used for 3 months before considering referral for possible tympanostomy tube placement, as indicated by recent clinical practice guidelines 1. Antibiotics work by targeting the common bacterial pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Patients should complete the full course of antibiotics even if symptoms improve, stay hydrated, and avoid air travel if possible until symptoms resolve. If symptoms worsen or don't improve within 48-72 hours of treatment, reevaluation is necessary to rule out complications or resistant infections. Recent literature emphasizes accurate diagnosis and optimal management of ear pain, with watchful waiting being an option in mild to moderate acute otitis media, and antibiotics shortening symptoms and duration of middle ear effusion 1. The role of tympanostomy tubes and adenoidectomy in recurrent acute otitis media and otitis media with effusion is still debated, but tympanostomy tubes can improve quality of life for children with chronic otitis media with effusion or recurrent acute otitis media 1.
Some key points to consider in the treatment of adult otitis media include:
- The importance of accurate diagnosis to reduce over-diagnosis, overtreatment, and antibiotic resistance 1
- The use of amoxicillin as the first-line antibiotic due to its effectiveness, safety, and narrow microbiologic spectrum 1
- The consideration of watchful waiting in mild to moderate cases before initiating antibiotic therapy 1
- The potential benefits and risks of tympanostomy tubes, including improved quality of life for some patients but also risks of complications such as suppurative otorrhea 1
From the Research
Treatment Options for Adult Otitis Media
- High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) is the recommended treatment for acute otitis media, despite increasing antimicrobial resistance 2
- For persistent or recurrent acute otitis media, guidelines recommend high-dose amoxicillin/clavulanate, cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone 2
- Twice-daily antibiotics, such as amoxicillin/clavulanate, can be effective in treating acute otitis media, with comparable outcomes to three times daily doses 3
- Trimethoprim-sulfamethoxazole has been shown to be more effective than amoxicillin-clavulanate in treating acute otitis media, with fewer side effects 4
- Amoxicillin/clavulanate has superior bacteriologic and clinical efficacy compared to azithromycin in children with acute otitis media 5
Considerations for Treatment
- The choice of antibiotic should be based on the suspected or confirmed pathogen, as well as the patient's medical history and potential allergies 2, 6
- Pharmacokinetic/pharmacodynamic principles should be considered in selecting antibiotics for acute otitis media 6
- Tympanocentesis can be useful in identifying the causative pathogen and guiding treatment 6
- The pneumococcal conjugate vaccine can help prevent recurrent acute otitis media and should be administered to all children less than 2 years old and those at risk 6