Otitis%20media%20-%20acute Treatment
Pharmacotherapy
Symptomatic Therapy
Analgesics
- Eg Paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) [eg Ibuprofen]
- Opioids may occasionally be indicated
- Considered the mainstay of pain relief for acute otitis media (AOM)
- Effective analgesia for mild-moderate pain
Antibiotic Therapy
- There are no data regarding initially withholding antimicrobial therapy in adult patients w/ AOM
- Treatment prevents development of complications
Amoxicillin/High-dose Amoxicillin
- Amoxicillin at sufficient doses is still considered the 1st-line agent for AOM
- It is effective against most of the bacteria which cause AOM including susceptible & intermediate-resistant pneumococci
- In areas where Penicillin-resistant pneumococci are common, high-dose Amoxicillin should be given
Amoxicillin/clavulanic Acid (High dose)
- High doses of Amoxicillin combined w/ clavulanic acid are recommended for patients who fail standard Amoxicillin therapy or in those who present w/ severe illness
- This combination will provide coverage for beta-lactamase-producing organisms (eg H influenzae & M catarrhalis along w/ Penicillin-resistant S pneumoniae)
Cephalosporins (2nd & 3rd Generation)
- Cefdinir, Cefpodoxime, Cefprozil & Cefuroxime are the preferred agents because of their effectiveness against drug-resistant S pneumoniae, H influenzae & M catarrhalis
- These agents may be considered in patients w/ non-type 1 hypersensitivity reaction to Penicillin
- Ceftriaxone [intravenous (IV)/intramuscular (IM)] may be considered in patients unable to take oral medications (eg vomiting)
- Also recommended x 3 days in patients who fail Amoxicillin/clavulanate
- Has superior efficacy to S pneumoniae compared w/ alternative oral antibiotics
Co-trimoxazole
- Co-trimoxazole may be considered in patients w/ type 1 allergy to Penicillin
- Use may be limited by local resistance patterns
Erythromycin/sulfafurazole
- May be considered in patients w/ type 1 allergy to Penicillin
- Depending on local resistance patterns, may be preferred over Co-trimoxazole
Advanced Macrolides
- Eg Azithromycin or Clarithromycin
- Active against the major pathogens that cause AOM
- These agents have decreased activity against drug-resistant S pneumoniae
Clindamycin
- May be considered in a patient who has persistent AOM after previous complete antibiotic therapy & in whom tympanocentesis is not possible for Gram stain & culture
- Clindamycin may be effective against Penicillin-resistant pneumococcal infection not responding to other treatment
- Clindamycin is not active against H influenzae or M catarrhalis & should not be used if these are suspected
Duration of Antibiotic Therapy
- Optimal duration of antimicrobial therapy in AOM patients is uncertain
- May continue antibiotics x 5-7 days in mild-moderate illness & up to 10 days if severe