University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• What is the minimal duration of antibiotics for effective treatment of acute otitis media?

Clinical Bottom Lines

1. 5 days of short-acting antibiotics are as effective as 8-10 days of treatment.
2. Azithromycin (5 days) or Ceftriaxone are as effective as 10 days of short-acting antibiotics.
3. To minimize use of "big-gun" antibiotics, restrict treatment to 5 days of short-acting antibiotics.

Summary of Key Evidence

1. 5 days of short-acting antibiotics vs. 8-10 days of short-acting antibiotics, evaluated at 20-30 days post-treatment: Odds Ratio (OR) for improvement was 1.22 (0.98-1.54); weighted Absolute Risk Reduction = 2.3%, results in a NNT of 43.¹
2. 3-5 days Azithromycin vs. 10 days short-acting antibiotics.  OR = 1.09 (0.86-1.38).
3. Cetriaxone vs. 10 days short-acting antibiotics.  OR = 1.25 (0.9-1.72).

Additional Comments

• Given the increasing resistance, one ought to restrict the use of board spectrum antibiotics.
• The short-course regimens are cheaper, secondary to the reduced amount of antibiotics needed.
• The short-course regimens have a potential, although not proven, reduction in side effects.
• Further studies may be warranted using even shorter courses of antibiotics treatment.
• The results of this study could be used in conjunction with initial 3 day "watchful waiting" with anti-inflammatory/analgesic use.  In other words, if there is no improvement after three days without antibiotics, one could select a short-course regimen.

Citation

1. Kozyrskyj AL. Hildes-Ripstein GE. Longstaffe SE. Wincott JL. Sitar DS. Klassen TP. Moffatt ME. Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. JAMA. 279(21):1736-42, 1998.

CAT Author: G. Matthew Hebdon, MD, PhD

CAT Appraisers: John G. Frohna, MD

Date appraised: March 23, 1999