Efficacy of short course (<4 days) of antibiotics for treatment of acute otitis media in children: A systematic review of randomized controlled trials

Abstract

There is no evidence of an increased risk of treatment failure with short course of antibiotics for acute otitis media. Among the short course regimens, azithromycin use was associated with a lower risk of treatment failure while short acting oral antibiotics and parenteral ceftriaxone may be associated with a higher risk of treatment failure.

Clinical practice guidelines for the diagnosis and management of acute otitis media in children—2018 update

“…In a systematic review of 35 RCTs, the number of treatment failure cases significantly increased when the oral antimicrobial agent was administered for less than 4 days (shortterm), as compared to being administered for 4 days or more. Because short-term administration increases the risk of treatment failure, they recommend that the antimicrobial treatment period should be 4 days or more [148] . In addition, a metaanalysis of 32 RCTs revealed that 5-day administration was sufficient as a duration of antimicrobial treatment for AOM patients without complications, based on a comparison of administration for less than 7 days or 8 days or more (8-19 days) [149] .…”

Etiology of Acute Otitis Media and Characterization of Pneumococcal Isolates After Introduction of 13-Valent Pneumococcal Conjugate Vaccine in Japanese Children

“…In An RCT comparing the effect by questionnaire of 3-day AMPC (40 mg/kg) and a placebo revealed no significant difference in the incidence of recurrence (Bezakova et al 2009). A systematic review analyzing 35 RCTs comparing the effects of short-term (< 4 days) and long-term (> 5 days) administrations of peroral antimicrobial agents on AOM in children revealed that the risk of treatment failure increased in the short-term group when short-acting antimicrobial agents were used (Gulani et al 2010). These results suggested that at least more than 4 days' administration of antimicrobial agents is recommended whenever necessary.…”

Acute otitis media in children

“…Risk of treatment failure is slightly higher with short courses of antibiotics (<7 days versus ≥7 days) one month after initiation of therapy (difference of 3% between groups) except for ceftriaxone and azithromycin 15,16…”