Effectiveness of shortened course (≤ 3 days) of antibiotics for treatment of acute otitis media in children
A systematic review of randomized controlled efficacy trials
WHO's current recommendation for antibiotic treatment of acute otitis media (middle-ear infection) is to give oral co-trimoxazole or amoxicillin for five days. In view of recent data which suggests that the duration of antibiotic treatment of non-severe pneumonia should be shortened from five to three days, a review was commissioned to determine whether it would also be possible to shorten the duration of treatment for acute otitis media.
A systematic review was conducted of 35 published clinical trials. The primary outcome was treatment failure at an evaluation point one month (31 days) after initiation of therapy. Overall, there was no evidence of an increased risk of treatment failure after one month with a short (three day) course of antibiotics for treating acute otitis media in children. There was a difference, however, between the outcomes of short course treatment using different antibiotics. Short course azithromycin use was associated with a lower risk of treatment failure than short-acting oral antibiotics like oral amoxicillin and parenteral ceftriaxone. Overall, adverse effects were significantly lower with the short course of treatment compared with the standard treatment of five days or more.