From the Guidelines
For adults with allergies to beta-lactams who have otitis media, macrolides, pristinamycin, and doxycycline are recommended as alternative treatments, as stated in the official French guidelines 1. When considering treatment options for otitis media in adults with beta-lactam allergies, it's crucial to prioritize alternatives that are effective against common pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Macrolides are a viable option, although increasing resistance may limit their effectiveness in some cases 1.
- Pristinamycin and doxycycline are also recommended as alternatives, particularly in the case of allergy to beta-lactams, as they provide a suitable benefit/risk ratio 1.
- It's essential to note that while cotrimoxazole may be considered, its inconsistent activity on pneumococci and poor benefit/risk ratio make it a less favorable choice 1.
- Supportive care, including analgesics like acetaminophen or ibuprofen for pain and inflammation, as well as antihistamines and decongestants to manage associated allergy symptoms, is also important in the overall management of otitis media in adults with beta-lactam allergies.
- The therapeutic choices for adults do not differ significantly from those for children, as the bacteria involved are the same, according to the official French guidelines 1.
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%)
Azithromycin can be used to treat otitis media in adults with allergies to beta lactams, as it has shown clinical success rates of 89% at Day 10 and 85% at Day 24 to 28 in pediatric patients.
- The bacteriologic eradication rates for common pathogens were:
- S. pneumoniae: 92% at Day 10 and 88% at Day 24 to 28
- H. influenzae: 71% at Day 10 and 64% at Day 24 to 28
- M. catarrhalis: 100% at both Day 10 and Day 24 to 28
- However, it is essential to note that these results are from pediatric patients, and the efficacy in adults may vary.
- The incidence of treatment-related adverse events was 12.1% in this study, with the most common side effects being vomiting, diarrhea, and abdominal pain 2
From the Research
Otitis Media in Adults with Allergies to Beta Lactams
- Otitis media (OM) is an infection of the middle ear, commonly caused by Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis 3.
- The emergence of penicillin-resistant strains of these pathogens is a major concern, and alternative treatments are being explored 3, 4.
- For adults with allergies to beta lactams, non-beta-lactam antibiotics such as macrolides (e.g., clarithromycin, azithromycin) may be effective alternatives 5, 6.
- Studies have shown that clarithromycin and azithromycin have antibacterial and anti-inflammatory efficacy in otitis media with effusion 5, 6.
- 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 7.
Alternative Treatments
- Vaccines and nasal sprays containing α-haemolytic streptococci with antimicrobial activity against OM pathogens are being developed as alternative treatments 3.
- Bacteriocins (natural antimicrobial peptides) and bacteriocin-like inhibitory substances (BLIS) produced by lactic acid bacteria may also be effective against OM pathogens 3.
- Macrolide antibiotics, such as erythromycin, clarithromycin, azithromycin, and roxithromycin, have been shown to have anti-inflammatory effects in otitis media with effusion 5.