Antibiotics prescribing acute otitis media (AOM)

This topic will discuss how to prescribe antibiotics prescribing acute otitis media (AOM)...
Abdelwahab Ward, BS Pharm, PharmD
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.

REFERENCES

Abdelwahab Ward, BS Pharm, PharmD