Empiric Therapy Regimens
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.
Uncomplicated acute otitis media in nonimmunocompromised adults
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
Uncomplicated acute otitis media in immunocompromised adults
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
Recurrent acute otitis media
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
Chronic otitis media
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.