A prospective observational study of 5-, 7-, and 10-day antibiotic treatment for acute otitis media.
OBJECTIVE
To compare 5-, 7- and 10-day duration of antibiotic therapy for acute otitis media (AOM) in children.


METHODS
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.
Pichichero
M E
ME
Elmwood Pediatric Group, University of Rochester Medical Center, New York 14642, USA. mepo@uhura.cc.rochester.edu
Marsocci
S M
SM
Murphy
M L
ML
Hoeger
W
W
Francis
A B
AB
Green
J L
JL
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D016870:Neisseriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015588:Observer Variation; D010034:Otitis Media with Effusion / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents