Adult Outpatients: Respiratory Tract Infections: Otitis Media

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Acute otitis media

 

OR

 

Otitis media with effusion (OME) with signs or symptoms of acute infection 

S. pneumoniae

H. influenzae

M. catarrhalis

Group A Strep.

Amoxicillin

1 g PO BID x 5-7 days 

OR

500 mg PO TID x 5-7 days 

For severe PCN allergy:

Azithromycin 500 mg PO daily x 1 day; then 250 mg PO daily x 4 days

OR

Doxycycline 100 mg PO BID for 5-7 days

Amoxicillin/clavulanic acid not indicated as initial therapy of acute otitis.

 

High dose amoxicillin 1 g PO TID should be used over low dose in the treatment of patients at risk for drug resistant S. pneumoniae.

 

OME in the absence of acute signs and symptom of infection does not require antibiotics.

 

For recurrent prolonged otitis consider ENT referral.