Vincen, D.R. (2017) New England Journal of Medicine. 376:e24
Hoberman et al. (Dec. 22 issue)1 conducted a well-designed trial that showed that a 10-day course of amoxicillin–clavulanate was superior to a 5-day regimen in children 6 to 23 months of age with acute otitis media. The investigators explain that they chose to study amoxicillin–clavulanate because it “is currently the most efficacious oral antimicrobial agent for the treatment of acute otitis media.”
But efficacy is not the only variable influencing such a treatment decision. High-dose amoxicillin is effective against common bacterial pathogens. It also has a favorable safety profile, a taste acceptable to children, a relatively low cost, and a narrower microbiologic spectrum than amoxicillin–clavulanate. It is this collective argument that professional societies around the world give for their recommendation of amoxicillin as the first-line agent for the treatment of acute otitis media in children.
Is it valid to infer that because a 10-day course of amoxicillin–clavulanate outperformed a 5-day course that similar results would follow if the antimicrobial agent under investigation were high-dose amoxicillin instead? If this inference is weak, why then did the investigators not study amoxicillin directly?
Read the full letter to the editor here
The original research article abstract is available here