Shortened Antimicrobial Treatment for Acute Otitis Media

Vincen, D.R. (2017) New England Journal of Medicine. 376:e24

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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

Pre- and post-admission antibiotic treatment in paediatric acute mastoiditis

Carmel, E. et al. (2017) The Journal of Laryngology & Otology. 131(S1) pp. S12-S17

Aim: To evaluate the effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis.

Conclusion: Paediatric acute mastoiditis patients treated with antibiotic therapy prior to admission are at higher risk for complication development. The advised time period for oral antibiotic therapy following hospital discharge remains as 10 days in all cases of uncomplicated acute mastoiditis.

Read the abstract here

Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children

Hoberman, A. et al. 92016) New England Journal of Medicine. 375:2446-2456

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Background: Limiting the duration of antimicrobial treatment constitutes a potential strategy to reduce the risk of antimicrobial resistance among children with acute otitis media.

Conclusions: Among children 6 to 23 months of age with acute otitis media, reduced-duration antimicrobial treatment resulted in less favorable outcomes than standard-duration treatment; in addition, neither the rate of adverse events nor the rate of emergence of antimicrobial resistance was lower with the shorter regimen.

Read the full abstract here

Close Follow-up in Children With Acute Otitis Media Initially Managed Without Antimicrobials

Uitti, J. et al. (2016) JAMA Pediatrics. 170 (11) pp. 1107-1108

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According to several national guidelines, close follow-up is required if initial observation without antimicrobial agents is chosen for the management of acute otitis media (AOM) in children.

The aim of this study was to examine whether close follow-up with reexamination is needed for children with AOM initially managed without antimicrobial agents who have symptomatic improvement during the first week after diagnosis, as assessed by their parents.

Read the full article here