Pittsburgh, PA—Despite the push to reduce overall use and duration of antibiotics, a 5-day antimicrobial treatment regimen for middle-ear infections in young children doesn’t work as well as the standard 10-day regimen, according to a new study.

Newly published research in the New England Journal of Medicine (NEJM) points out that acute otitis media is a common childhood illness often caused by bacteria and usually treated with antibiotics. Because overuse or inappropriate use of antibiotics is bolstering the emergence and spread of antimicrobial resistance, prescribers are being urged to limit treatment with the drugs.

For the study, University of Pittsburgh School of Medicine–led researchers examined whether a shortened regimen worked as well as the standard 10-day treatment course for middle-ear infection. They also looked at whether the compressed duration reduced the risk of antimicrobial resistance.

Enrolled in the double-blind study were 520 children aged 6 to 23 months who were diagnosed with middle-ear infection using strict diagnostic criteria. Participants were randomly assigned to receive the antibiotic amoxicillin-clavulanate for either 10 days or 5 days, with those in the 5-day group taking a placebo for 5 additional days.

Results indicate that 34% of 229 participants in the 5-day treatment group experienced clinical failure, or a worsening of symptoms and signs of infection, as compared with 16% of 238 participants in the 10-day treatment group.

When, following treatment, researchers examined bacteria samples from the children's nose and throat cavities to identify resistant bacteria, they were surprised to find no significant difference in levels between the two treatment groups. The study team said it had expected that reducing the duration of antibiotic therapy would decrease the potential for antimicrobial resistance.

“We found no significant between-group differences in rates of recurrence, adverse events, or nasopharyngeal colonization with penicillin-nonsusceptible pathogens,” study authors conclude. “Clinical-failure rates were greater among children who had been exposed to three or more children for 10 or more hours per week than among those with less exposure and were also greater among children with infection in both ears than among those with infection in one ear.”

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