Otitis%20media%20-%20acute Treatment

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