Limiting duration of antibiotics in OM limits their effectiveness

Treating children with acute otitis media (OM) with amoxicillin-clavulanate for 5 days is less effective than following standard 10-day treatment, according to a study in 520 such children who were aged 6 to 23 months.

Investigators assigned the children in the multisite trial to receive either a 10-day course of amoxicillin-clavulanate at a total daily dose of 90 mg of amoxicillin and 6.4 mg of clavulanate per kilogram of body weight, or a 5-day course of the antibiotic followed by 5 days of placebo. They assessed the children on days 4, 5, and 6 through telephone conversations with their parents and with an office visit at the end of treatment. In addition, each day parents recorded their child’s symptom scores on the Acute Otitis Media-Severity of Symptoms (AOM-SOS) scale. Finally, investigators scheduled in-office assessments every 6 weeks through the end of the respiratory-infection season.

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Compared with children who received the 10-day treatment, a larger proportion of those on the 5-day regimen experienced clinical failure (34% vs 16%), defined as worsening of symptoms or otoscopic signs of infection (Hoberman A, et al. N Engl J Med. 2016;375[25]:2446-2456).

My take

Although there is a movement to reduce duration of antibiotic therapy for many conditions as a means of limiting resistance and complications, at least for children aged younger than 2 years, 10 days rather than 5 days of treatment seems like the best choice for OM. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.