From the Guidelines
Adult otitis media should be treated with amoxicillin as the first-line antibiotic, prescribed at a dosage of 80 to 90 mg per kg per day, due to its effectiveness against susceptible and intermediate resistant pneumococci, as well as its safety, affordability, and acceptable taste.
Key Considerations
- The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present, with amoxicillin being the preferred option due to its narrow microbiologic spectrum and effectiveness against the most common pathogens, including S. pneumoniae, H. influenzae, and M. catarrhalis 1.
- If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, alternative antibiotics such as cefdinir, cefpodoxime, or cefuroxime can be prescribed 1.
- Pain management is also crucial in the treatment of adult otitis media, and can be achieved with acetaminophen or ibuprofen.
Treatment Approach
- The optimal duration of therapy for patients with AOM is uncertain, but treatment is typically given for 5-7 days.
- For otitis media with effusion, a watchful waiting approach is often recommended for 3 months as many cases resolve spontaneously.
- Decongestants and antihistamines are generally not recommended as they show limited benefit.
- If symptoms persist or worsen despite antibiotic therapy, or if there are complications such as hearing loss or persistent effusion, referral to an ENT specialist is warranted 1.
Patient Education
- Patients should avoid getting water in the affected ear and can use a warm compress to help alleviate pain.
- The treatment aims to eliminate infection, reduce inflammation, relieve pain, and prevent complications such as hearing loss or spread of infection.
From the FDA Drug Label
Adult Patients Acute Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease In a randomized, double-blind controlled clinical trial of acute exacerbation of chronic bronchitis (AECB), azithromycin (500 mg once daily for 3 days) was compared with clarithromycin (500 mg twice daily for 10 days).
The FDA drug label does not answer the question about adult otitis media treatment.
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, alternative treatments include high-dose amoxicillin/clavulanate, cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone 2
- Azithromycin has been shown to be effective in preventing recurrent acute otitis media, with a clinical response comparable to amoxicillin 3
Comparison of Antimicrobial Agents
- Amoxicillin-clavulanate has been found to be superior to azithromycin, cefdinir, placebo, cefaclor, and penicillin V in some studies, while having comparable efficacy in others 4
- Trimethoprim-sulfamethoxazole has been shown to be more effective than amoxicillin-clavulanate in some cases, with a higher combined rate of cure and improvement 5
- Azithromycin has been associated with a decreased risk of treatment failure overall, but an increased risk of failure during the first few days of treatment 6