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. STUDY DESIGN AND SETTING: Prospective nonrandomized I-year evaluation of 3 treatment durations for AOM in a private pediatric setting. Outcomes assess ed at 14 +/- 4 days after start of therapy with clinical response categoriz ed as cure, improvement, or failure. RESULTS: A total of 2172 children were studied; 46.4% were less than or equ al to2-years-old. Antibiotics used were amoxicillin (61.9% of patients), tr imethoprim/sulfamethoxazole (11.7%), cephalosporins (14.2%), amoxicillin/cl avulanate (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 less than or equal to2-years- old. However, in the subset who had an episode of AOM in the preceding mont h, outcome differed; 5-day treatment was followed by more frequent failure than 10-day treatment (P <0.001). In logistic regression analysis, variable s 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 standa rd 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 t he otitis-prone patient.