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Practice Variation in Antibiotic Duration for Acute Otitis Media in Children Aged 2 to 5 Years: Five Versus 7 Days in

Andrea Rivera-Sepulveda1, Nabeel Mohammad2, Adaobi Okocha1

  • 1Department of Pediatrics, Nemours Children's Health.

Pediatric Emergency Care
|August 5, 2026
PubMed

Insights

A 5-day antibiotic course for acute otitis media (AOM) in children aged 2-5 years showed similar short-term outcomes to a 7-day course. This finding supports guideline-concordant prescribing and antimicrobial stewardship in pediatric care.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Outcomes Research

Background:

  • Acute otitis media (AOM) is a common pediatric infection and a frequent reason for antibiotic prescriptions.
  • Current guidelines suggest 5-7 days of antibiotic therapy for uncomplicated AOM in children aged 2-5 years, but prescribing durations vary.
  • This study investigates the efficacy of a 5-day versus a 7-day antibiotic course for uncomplicated AOM.

Purpose of the Study:

  • To compare short-term treatment outcomes for uncomplicated acute otitis media (AOM) in children aged 2-5 years treated with 5-day versus 7-day antibiotic courses.
  • To evaluate the association between antibiotic duration and treatment failure.
  • To inform clinical practice and antimicrobial stewardship efforts regarding AOM management.

Main Methods:

  • Retrospective multicenter cohort study utilizing electronic health record data.
  • Inclusion of children aged 2-5 years diagnosed with uncomplicated AOM and treated with a single oral antibiotic in 2022.
  • Primary analysis compared treatment failure rates (defined as AOM-related return encounter requiring new antibiotic prescription within 7 days post-therapy) between 5-day and 7-day treatment groups.

Main Results:

  • The study included 7528 children, with 906 receiving a 5-day course and 1799 receiving a 7-day course.
  • Treatment failure rates were 0.44% for the 5-day group and 0.61% for the 7-day group (absolute risk difference: -0.17%).
  • No statistically significant difference in short-term treatment failure was observed between the 5-day and 7-day antibiotic regimens, with consistent findings across subgroup and sensitivity analyses.

Conclusions:

  • A 5-day antibiotic course for uncomplicated acute otitis media in children aged 2-5 years is not associated with an increased risk of short-term treatment failure compared to a 7-day course.
  • These findings support adherence to guideline recommendations for antibiotic duration in AOM.
  • The results advocate for the implementation of shorter antibiotic courses to enhance outpatient antimicrobial stewardship in pediatric populations.
Abstract

Keywords:
acute otitis mediaantibioticsshort coursestewardship

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