What is the recommended duration and dosage of Augmentin (amoxicillin‑clavulanate) for uncomplicated acute otitis media in an otherwise healthy adult?

Duration of Augmentin for Acute Otitis Media in Adults

For uncomplicated acute otitis media in adults, treat with Augmentin 875 mg/125 mg orally twice daily for 5-7 days, with reassessment at 48-72 hours if no clinical improvement occurs. 1, 2

When to Use Augmentin vs. Plain Amoxicillin

Amoxicillin alone (1.5-4 g/day divided into 2-3 doses) should be first-line therapy for uncomplicated acute otitis media in adults due to its effectiveness, safety, low cost, and narrow microbiologic spectrum. 1, 2

Switch to Augmentin as initial therapy in these specific situations:

• Recent antibiotic use within the previous 4-6 weeks 1, 2
• Treatment failure after 72 hours of amoxicillin therapy 1, 2
• Moderate to severe infection with high fever (≥39°C/102°F) or systemic toxicity 1
• High-risk patients: age >65 years, diabetes, chronic cardiac/hepatic/renal disease, or immunocompromised status 1
• Geographic areas with high resistance rates (>10% penicillin-nonsusceptible S. pneumoniae) 1
• Close contact with healthcare environments or daycare facilities 1

Dosing Regimens

Standard-risk adults: Augmentin 875 mg/125 mg (or 1.75 g/250 mg per day) divided into 2-3 doses 1, 2

High-risk patients or those with recent antibiotic exposure: High-dose Augmentin 4 g/250 mg per day divided into 2-3 doses 1, 2

Treatment Duration

The recommended duration is 5-7 days for uncomplicated cases in adults. 1, 2 While traditional 10-day courses have been studied in most trials, shorter durations of 5-7 days are now preferred to reduce unnecessary antibiotic exposure. 1, 3

Critical reassessment point: Evaluate the patient at 48-72 hours if no clinical improvement occurs. 1, 2 This timeframe is essential because failure to improve suggests either resistant pathogens requiring broader coverage or a non-bacterial etiology requiring diagnostic reevaluation. 1

Alternatives for Penicillin Allergy

For non-type I penicillin allergy:

• Cefdinir 300 mg twice daily or 600 mg once daily 1, 2
• Cefuroxime axetil 500 mg twice daily 1, 2
• Cefpodoxime proxetil 1, 2

For immediate Type I hypersensitivity:

• Doxycycline 1
• Respiratory fluoroquinolones (levofloxacin or moxifloxacin) 1

Adjunctive Therapies

Recommend these supportive measures alongside antibiotics:

• Intranasal saline irrigation (physiologic or hypertonic) 1
• Intranasal corticosteroids, especially in patients with allergic rhinitis history 1
• Analgesics for pain management 4

Avoid oral or topical decongestants and antihistamines as they are not recommended for acute otitis media. 1

When to Switch Therapy

Change antibiotics if symptoms worsen or fail to improve after 48-72 hours of initial therapy. 1, 2 This indicates either a resistant pathogen requiring broader coverage, a non-bacterial etiology, or the need for high-dose formulation if not already prescribed. 1

Common Pitfalls to Avoid

Do not routinely cover MRSA in initial empiric therapy—current data does not support this approach for uncomplicated acute otitis media. 1

Avoid macrolides (azithromycin, clarithromycin) and trimethoprim-sulfamethoxazole as first-line agents due to high resistance rates (>40% and 50% respectively) among common otitis media pathogens. 1 While macrolides may be considered in penicillin-allergic patients, they have limited effectiveness against common pathogens. 2

Do not prescribe durations shorter than 5 days—research demonstrates that 5-day regimens of amoxicillin-clavulanate are inferior to 7-10 day regimens for clinical response, though they may be sufficient for modest treatment goals. 3