From the Guidelines
For adults with penicillin allergy who have otitis media, the best treatment is typically a cephalosporin such as cefdinir (14 mg/kg per day in 1 or 2 doses) or cefuroxime (30 mg/kg per day in 2 divided doses), as they have lower cross-reactivity with penicillins than previously thought 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the penicillin allergy and the likelihood of cross-reactivity with cephalosporins.
- Cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 1.
- If the penicillin allergy is severe, alternative treatments such as macrolide antibiotics (e.g., azithromycin) or fluoroquinolones (e.g., levofloxacin) may be considered 1.
Treatment Options
- Cefdinir (14 mg/kg per day in 1 or 2 doses) or cefuroxime (30 mg/kg per day in 2 divided doses) for non-severe penicillin allergy 1.
- Azithromycin (500 mg on day 1, followed by 250 mg daily for 4 more days) or clarithromycin (500 mg twice daily for 7-10 days) for severe penicillin allergy or as an alternative treatment 1.
- Levofloxacin (750 mg once daily for 5-7 days) for resistant infections or as an alternative treatment 1.
Additional Recommendations
- Pain management is also important - use acetaminophen (650 mg every 6 hours as needed) or ibuprofen (400-600 mg every 6-8 hours with food) to manage pain and discomfort.
- Applying warm compresses to the affected ear can provide additional comfort.
- If symptoms don't improve within 48-72 hours of starting antibiotics, or if they worsen at any point, follow-up with a healthcare provider is necessary as drainage or culture may be required.
From the FDA Drug Label
In a non-comparative clinical and microbiological trial, 248 patients from 6 months to 12 years of age with documented acute otitis media were dosed with a single oral dose of azithromycin (30 mg/kg on Day 1). For the 240 patients who were evaluable for clinical modified Intent-to-Treat (MITT) analysis, the clinical success rate (i.e., cure plus improvement) at Day 10 was 89% and for the 242 patients evaluable at Day 24 to 28, the clinical success rate (cure) was 85%. Presumed Bacteriologic Eradication Day 10Day 24–28 S. pneumoniae70/76 (92%)67/76 (88%) H. influenzae30/42 (71%)28/44 (64%) M catarrhalis10/10 (100%)10/10 (100%) Overall110/128 (86%)105/130 (81%)
The best otitis media treatment for an adult with penicillin allergy is azithromycin.
- The clinical success rate for azithromycin in treating acute otitis media is 89% at Day 10 and 85% at Day 24 to 28.
- Azithromycin has been shown to be effective against common pathogens that cause otitis media, including S. pneumoniae, H. influenzae, and M. catarrhalis.
- The most common side effects of azithromycin are diarrhea, vomiting, and abdominal pain. 2
From the Research
Otitis Media Treatment for Adults with Penicillin Allergy
- The provided studies primarily focus on the treatment of acute otitis media in children, with limited direct application to adults with penicillin allergy.
- However, some antibiotics mentioned in the studies can be considered for adults with penicillin allergy, such as macrolides (e.g., clarithromycin, azithromycin) 3, 4, 5, 6.
- Clarithromycin has been shown to be effective in treating acute otitis media caused by penicillin-susceptible, -intermediate, and -resistant Streptococcus pneumoniae in animal models 4.
- Azithromycin has been compared to clarithromycin in children with acute otitis media and found to have similar efficacy and safety profiles 5.
- A population-based study found that azithromycin was associated with a decreased risk of treatment failure in children with acute otitis media, compared to amoxicillin 6.
- Trimethoprim-sulfamethoxazole has also been shown to be effective in treating acute otitis media, although its use may be limited by resistance patterns and side effects 7.