A prospective observational study of 5-, 7-, and 10-day antibiotic treatment for acute otitis media
M E Pichichero1, S M Marsocci, M L Murphy
1Elmwood Pediatric Group, University of Rochester Medical Center, New York 14642, USA. mepo@uhura.cc.rochester.edu
Insights
For most children, a 5-day antibiotic course is effective for acute otitis media (AOM). However, children with a recent history of AOM may benefit from a longer, 10-day antibiotic treatment regimen.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Optimal antibiotic treatment duration for AOM is debated.
- Previous guidelines recommended longer antibiotic courses.
Purpose of the Study:
- To compare the efficacy of 5-, 7-, and 10-day antibiotic therapy durations for AOM in children.
- To identify patient subgroups that may benefit from specific treatment durations.
Main Methods:
- Prospective, nonrandomized study over 1 year in a pediatric setting.
- 2172 children with AOM were evaluated.
- Outcomes (cure, improvement, failure) assessed 14 days post-therapy.
Main Results:
- No significant difference in overall treatment outcomes between 5-, 7-, and 10-day regimens.
- Children with a recent prior AOM episode showed higher failure rates with 5-day treatment compared to 10-day.
- Factors for cure included age over 2 years and no recent AOM history.
Conclusions:
- A 5-day antibiotic course is generally sufficient for most AOM cases.
- A 10-day regimen may be more effective for children with recurrent AOM.
- This supports a shift towards shorter antibiotic durations for standard AOM treatment.
Objective:
To compare 5-, 7- and 10-day duration of antibiotic therapy for acute otitis media (AOM) in children.
Study Design And Setting:
Prospective nonrandomized 1-year evaluation of 3 treatment durations for AOM in a private pediatric setting. Outcomes assessed at 14 +/- 4 days after start of therapy with clinical response categorized as cure, improvement, or failure.
Results:
A total of 2172 children were studied; 46.4% were < or =2-years-old. Antibiotics used were amoxicillin (61.9% of patients), trimethoprim/sulfamethoxazole (11.7%), cephalosporins (14.2%), amoxicillin/clavulanate (5.2%), and macrolides/azalides (4.8%). No overall difference in outcome was observed comparing the 5-day (n = 707), 7-day (n = 423), or 10-day (n = 1042) treatments, including children < or =2-years-old. However, in the subset who had an episode of AOM in the preceding month, outcome differed; 5-day treatment was followed by more frequent failure than 10-day treatment (P < 0.001). In logistic regression analysis, variables identified as contributing to a cure were: >2-years-old (P < 0.0001), no AOM in the preceding month (P = 0.07), or preceding 12 months (P = 0.03).
Conclusions:
Our study supports the transition from 10 to 5 days for standard AOM antibiotic treatment duration in most patients. A 10-day regimen may be superior in children who have experienced an episode of AOM within the preceding month, a known risk factor for resistant bacterial infection in the otitis-prone patient.
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