Antibiotics prescribing acute otitis media (AOM)

byAbdelwahab Ward, BS Pharm, PharmD - last updated
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OVERVIEW ã…¡ Optimize analgesia and target antibiotics. AOM resolves in 60% within 24h without antibiotics. Consider 2 or 3-day delayed, or immediate antibiotics for pain relief. Average total length of illness is 4 days. Routine follow-up is not required in the absence of persistent symptoms.

ANTIBIOTIC PRESCRIBING

An antibiotic regimen plus symptom management is the first-line approach in adults with acute otitis media. A "wait and see" approach that delays the use of antibiotics to see if spontaneous resolution occurs has not been evaluated in adults. Antibiotic options include amoxicillin/clavulanate (Augmentin) 1 g every 12 hours. Alternatives for patients with penicillin allergy include
    • Cefdinir 300 mg every 12 hours or 600 mg every 24 hours 
    • Cefuroxime 250 mg every 12 hours
    • Cefpodoxime 200 mg every 12 hours
    • Azithromycin 500 mg as single dose on day 1, then 250 mg once daily on days 2-5 
    • Clarithromycin 500 mg every 12 hours
    • Cefprozil 250 mg every 12 hours, or 500 mg every 12 hours for more severe infections
Consider oral analgesics such as acetaminophen and/or ibuprofen for pain control. Most patients may be managed as outpatients but if the patient does not improve after 48-72 hours of initial antibiotic therapy, consider alternative antibiotics including amoxicillin-clavulanate 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours; or if severe infection 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours, levofloxacin 750 mg every 24 hours for 5 days, or 500 mg every 24 hours or moxifloxacin 400 mg every 24 hours. If complications develop, consider inpatient management with IV antibiotics and/or otolaryngology consult.

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