Antibiotics prescribing acute otitis media (AOM)
Overview
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
- Szmuilowicz, J., & Young, R. (2019). Infections of the Ear. Emergency Medicine Clinics of North America, 37(1),1–9.
- NICE. Clinical Knowledge Summary, Otitis media – acute. Available at: https://cks.nice.org.uk/otitis-media-acute.
