Acute Otitis Media Outcomes Examined with Reduced- vs. Standard-Duration Antibiotics

Rate of emergence of antimicrobial resistance was not lower with shorter regimen
Rate of emergence of antimicrobial resistance was not lower with shorter regimen

In young children with acute otitis media, reduced-duration antimicrobial treatment led to less favorable outcomes vs. standard-duration treatment, a study published in the New England Journal of Medicine found.

Study author Alejandro Hoberman, MD, explained that shortening the duration of antimicrobial treatment could be a potential strategy to decrease the risk of antimicrobial resistance among children with acute otitis media. To investigate this, Dr. Hoberman and colleagues assigned 520 young children aged 6–23 months with acute otitis media to receive amoxicillin-clavulanate for either 10 days or for 5 days with a placebo for 5 days. 

They measured the rates of clinical response on the basis of signs and symptomatic response, recurrence, nasopharyngeal colonization, and episode outcomes; symptom scores ranged from 0–14. 

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The data indicated children who were treated for 5 days were more likely to experience clinical failure vs. children treated for 10 days (34% vs. 16%, 95% CI: 9–25). The mean symptom scores over the period from Day 6–14 were 1.61 in the 5-day treatment group and 1.34 in the 10-day treatment group (P=0.07); the mean scores at the Day 12–14 assessment were 1.89 vs. 1.20 (P=0.001). There was also a lower percentage of children whose symptom scores decreased >50% from baseline to the end of treatment in the 5-day treatment group vs. the 10-day treatment group (80% vs. 91%; P=0.003).

"We found no significant between-group differences in rates of recurrence, adverse events, or nasopharyngeal colonization with penicillin-nonsusceptible pathogens," reported Dr. Hoberman.

Rates of clinical failure were higher among children who had been exposed to ≥3 children for ≥10 hours weekly vs. children who had less exposure (P=0.02) and were higher among children with infection in both ears vs. those with infection in one ear (P<0.001).

For more information visit nejm.org.