Treatment Duration for Adult Acute Otitis Media
Adults with acute otitis media should receive a 5-day course of antibiotics. 1
Recommended Treatment Duration
The European Society of Clinical Microbiology and Infectious Diseases specifically recommends 5 days of antibiotic therapy for adults and children over 2 years with AOM, representing a departure from the traditional 10-day course that was historically borrowed from streptococcal pharyngotonsillitis protocols rather than derived from otitis media-specific evidence. 1
This shorter 5-day duration contrasts sharply with the 8-10 day course required for children under 2 years, reflecting age-based differences in immune response and infection clearance. 1
First-Line Antibiotic Selection
Amoxicillin-clavulanate is the preferred first-line agent for treating AOM in adults due to its coverage against beta-lactamase-producing organisms (H. influenzae and M. catarrhalis). 1
Alternative first-line options include cefuroxime-axetil and cefpodoxime-proxetil, both providing adequate coverage against beta-lactamase-producing pathogens. 1
The causative bacteria in adult AOM are identical to those in children: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. 1
Treatment Failure Management
Treatment failure is defined as worsening condition, persistence of symptoms beyond 48 hours after starting antibiotics, or recurrence of symptoms within 4 days of treatment discontinuation. 1
If treatment fails, reassess the diagnosis and consider changing antibiotics based on the initial agent prescribed. 1
Alternative Regimens for Penicillin Allergy
For patients with beta-lactam allergies, alternative options include erythromycin-sulfafurazole, macrolides, and doxycycline, though these carry bacteriologic failure rates of 20-25% due to increasing antibiotic resistance. 1
Fluoroquinolones inactive against pneumococci (ofloxacin, ciprofloxacin) should be avoided for AOM treatment. 1
Critical Diagnostic Considerations
Do not prescribe antibiotics for isolated tympanic membrane redness with normal landmarks, as this is not an indication for antibiotic therapy. 1
Adequate visualization of the tympanic membrane is essential before prescribing antibiotics to avoid overdiagnosis and inappropriate antibiotic use. 1
Important Caveats
NSAIDs and corticosteroids have not demonstrated efficacy in acute otitis media treatment. 1
Ceftriaxone IM injections should only be used in exceptional circumstances. 1
Antibiotic resistance, particularly with S. pneumoniae, H. influenzae, and M. catarrhalis, is an increasing concern that makes appropriate antibiotic selection crucial. 1