Shortened Duration is Ineffective for Treating Acute Otitis Media

A new study found that reduced duration of antimicrobial treatment for middle ear infections in children does not reduce the emergence of antimicrobial resistance and has less favorable outcomes than the standard-duration treatment.

The study included a cohort of 520 children between 6 to 23 months with acute otitis media who either received amoxicillin–clavulanate for 10 days (standard duration), or received amoxicillin–clavulanate for 5 days and a placebo for another 5 days. Researchers measured clinical responses, recurrence, and nasopharyngeal colonization, analyzed episode outcomes using a noninferiority approach, and scored the severity of symptoms from 0 to 14.
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The results showed that 34% of the children on the 5-day duration were more likely to have clinical failure compared to 16% of children in the 10-day duration. Additionally, only 80% of the children in the 5-day duration for treatment showed a decrease in more than 50% of symptoms. Conversely, 91% of children in the 10-day duration saw a decrease in symptoms of more than 50%. There was no statistical significance for rates of recurrence, adverse events, or nasopharyngeal colonization with penicillin-nonsusceptible pathogens between the two groups.

Researchers found that clinical failure rates were higher in children exposed to 3 or more children for 10 or more hours during the week, and greater in children who had infections in both ears.

Overall, the findings indicated that shortening the duration of treatment does not prevent antimicrobial resistance and has a higher rate of clinical failure then the standard duration.

—Melissa Weiss

Reference:

Hoberman A, Paradise JL, Rockette HE, et al. Shortened antimicrobial treatment for acute otitis media in young children [published online December 22, 2016]. New England Journal of Medicine. doi:10.1056/NEJMoa1606043.