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Less is not more for ear infections

A five-day course of antibiotic treatment for middle ear infections in young children is inferior to the standard 10-day regimen, according to a study published in The New England Journal of Medicine [NEJM].

Middle ear infections, known as acute otitis media, are common childhood illnesses often caused by bacteria, and are generally treated with antibiotics. However, overuse or misuse of antibiotics – for example, to treat viral infections of the middle ear – can cause antimicrobial resistance, an increasing problem which is making infections tougher to treat and rendering traditional antibiotics less effective.

In the NEJM study, scientists from the University of Pittsburgh looked at whether a five-day regimen worked as well as the standard 10-day treatment course for middle ear infection, and also whether a shortened regimen reduced the risk of antimicrobial resistance.

The study included 520 children, aged 6 to 23 months, who had been diagnosed with middle ear infections. Investigators randomly assigned the children to receive the antibiotic amoxicillin clavulanate for either five days or 10 days. Those in the five-day group then took a placebo for five additional days. Investigators monitored the children’s symptoms and signs of infection both during and after treatment.

The study found that 34 percent of the children in the five-day treatment group experienced a worsening of symptoms and signs of infection, compared to 16 percent in the 10-day treatment group. Following treatment, researchers also examined bacteria samples to test for the presence of resistant bacteria. They found no significant difference in levels of resistant bacteria between the two treatment groups, concluding that the standard 10-day antibiotic regimen remains the preferred treatment for childhood middle ear infections.

A 10-day course of antibiotics remains the best treatment for pediatric ear infections.

Pediatricians should stick with the traditional 10-day course of antibiotics for pediatric ear infections, new research shows.

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