Amoxicillin best for treatment of acute otitis media in children: study

Acute otitis media (AOM) is defined as an infection of the middle ear and is the second most common pediatric diagnosis in the emergency department following upper respiratory infections. Although acute otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months

A study was conducted to compare the antibiotic treatment failure and recurrence rates between antibiotic agents (amoxicillin, amoxicillin-clavulanate, cefdinir, and azithromycin) for children with uncomplicated acute otitis media (AOM)

They completed a retrospective cohort study of children 6 months-12 years of age with uncomplicated acute otitis media identified in a nationwide claims database. The primary exposure was antibiotic agent, and the primary outcomes were treatment failure and recurrence. Logistic regression was used to estimate odds ratios and analyses were stratified by primary exposure, patient age and antibiotic duration.

Results:

• Among the 1,051,007 children included in the analysis, 56.6% were prescribed amoxicillin, 13.5% amoxicillin-clavulanate, 20.6% cefdinir, and 9.3% azithromycin.
• Most prescriptions (93%) were for 10 days and 98% were filled within 1 day of the medical encounter.
• Treatment failure or recurrence occurred in 2.2% and 3.3% of children, respectively.
• Combined failure and recurrence rates were low for all agents including amoxicillin amoxicillin-clavulanate 11.3%; cefdinir 10.0% (9.8, 10.1); azithromycin 9.8%

Thus, despite microbiologic changes in acute otitis media etiology, treatment failure and recurrence were uncommon for all antibiotic agents and were lower for amoxicillin than for other agents. These findings support the continued use of amoxicillin as a first-line agent for acute otitis media when antibiotics are prescribed.

Reference:

Frost HM, Bizune D, Gerber JS, Hersh AL, Hicks LA, Tsay SV. Amoxicillin versus other antibiotic agents for the treatment of acute otitis media in children. J Pediatr. 2022 Aug 6:S0022-3476(22)00674-6. doi: 10.1016/j.jpeds.2022.07.053. Epub ahead of print. PMID: 35944719.

Keywords:

Holly M Frost, Destani Bizune, Jeffrey S Gerber, Adam L Hersh, Lauri A Hicks, Sharon V Tsay, journal of paediatrics, Amoxicillin, other, antibiotic, agents, treatment, acute otitis media, children