Acute Otitis Media Empiric Therapy 

Updated: Jan 24, 2019
Author: Brenda L Natal, MD, MPH; Chief Editor: Thomas E Herchline, MD 

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.[1, 2, 3, 4]

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.[3]