Acute Otitis Media Empiric Therapy
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The preferred antibacterial drugs should be effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Streptococcus pyogenes and Pseudomonas pneumoniae are also listed as frequent microbiologic infections in the adult population. [1, 2, 3, 4]
See the list below:
Amoxicillin 875 mg PO BID or 500 mg TID for 5-7d or
Cefuroxime 500 mg PO BID for 5-7d or
Cefpodoxime 200 mg PO BID for 5-7d or
Cefdinir 300 mg PO BID for 5-7d or
Ceftriaxone 2 g IM/IV once
Penicillin-allergic patients:
Levofloxacin 500 mg/day PO for 7-10d or
Moxifloxacin 400 mg/day PO for 7-10d or
Clindamycin 300 mg PO TID/QID for 7-10d
See the list below:
Amoxicillin-clavulanate 875 mg/125 mg PO BID or 500 mg PO TID for 10-14d or
Cefpodoxime 200 mg PO BID for 7-10d or
Cefdinir 300 mg PO BID for 7-10d or
Clindamycin 300 mg PO TID for 7-10d
No antibiotics within past month:
Amoxicillin-clavulanate 875 mg/125 mg PO BID for 7-10d or
Cefdinir 300 mg PO BID for 7-10d or
Cefpodoxime 200 mg PO BID for 7-10d or
Cefprozil 500 mg PO BID for 10d or
Cefuroxime 500 mg PO BID for 7-10d or
Ceftriaxone 1 g/day IM for 3d
Antibiotics within past month:
Ceftriaxone 1 g/day IM for 3d or
Clindamycin 300 mg PO TID for 7-10d
Refer the patient to a specialist to rule out chronic otomastoiditis or cholesteatoma in the setting of chronic otitis media.
P aeruginosa and Staphylococcus aureus have been described as common causes of chronically infected ears in adults. [3]
Park JH, Park SJ, Kim YH, et al. Sensorineural hearing loss: a complication of acute otitis media in adults. Eur Arch Otorhinolaryngol. 2014 Jul. 271(7):1879-84. [Medline].
Natal BN, Chao JH. Emergent Management of Acute Otitis Media. Medscape Reference. Available at http://emedicine.medscape.com/article/764006-overview. 2017 Aug 02; Accessed: 2019 Jan 23.
Laulajainen Hongisto A, Jero J, Markkola A, Saat R, Aarnisalo AA. Severe Acute Otitis Media and Acute Mastoiditis in Adults. J Int Adv Otol. 2016 Dec. 12 (3):224-230. [Medline]. [Full Text].
Kaplan DM, Gluck O, Kraus M, Slovik Y, Juwad H. Acute bacterial meningitis caused by acute otitis media in adults: A series of 12 patients. Ear Nose Throat J. 2017 Jan. 96 (1):20-28. [Medline].
Brenda L Natal, MD, MPH Assistant Professor of Emergency Medicine, Simulation Director, Rutgers New Jersey Medical School; Attending Physician, Department of Emergency Medicine, University Hospital of Newark
Brenda L Natal, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association
Disclosure: Nothing to disclose.
Jennifer H Chao, MD, FAAP Clinical Associate Professor of Pediatric Emergency Medicine, State University of New York Downstate College of Medicine; Attending Physician, Pediatric Emergency Department, Kings County Hospital and University Hospital Brooklyn
Jennifer H Chao, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic
Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio
Disclosure: Nothing to disclose.
Acute Otitis Media Empiric Therapy
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