499 - Effectiveness of 5- Versus 7-Day Antibiotic Courses for Acute Otitis Media in Children Aged 2-5 Years: A Multicenter Retrospective Cohort Study

Publication Number: 4490.499

Andrea Rivera-Sepulveda, Nemours Children's Hospital, ORLANDO, FL, United States; Nabeel Mohammad, University of Central Florida College of Medicine, Orlando, FL, United States; Adaobi Okocha, Nemours Children's Hospital, Atlanta, GA, United States; Sophia Blumenfeld, Mayo Clinic Alix School of Medicine, Jacksonville, FL, United States; Arezoo Zomorrodi, Nemours Children's Hospital, Newtown Sq, PA, United States

Background: Acute otitis media (AOM) is a common pediatric infection often requiring antibiotic treatment. The optimal antibiotic duration for AOM among children 2-5 years remains uncertain, with common practice ranging from 5 to 7 days.

Objective: This study aimed to compare treatment failure after exactly 5 versus 7 days of therapy in routine care.

Design/Methods: We performed a retrospective multicenter cohort study across an integrated pediatric system (primary care, urgent care, emergency department) in 2022. Eligible encounters included children aged 2-5 years with a diagnosis of AOM who received a prescription for a single oral antibiotic. The primary exposure contrasted 5-day with 7-day regimens; a secondary analysis examined >=5, 6-7, and >7 days. The primary outcome was treatment failure, defined as a return visit within 7 days of the index encounter culminating in a new antibiotic prescription for AOM. Group differences were assessed with chi-squared/Fisher tests and reported with absolute risks.

Results: Among 6,389 children (median age 3 years; 55% male), amoxicillin was prescribed in 89.5% and cefdinir in 10.5%. Duration distribution was 5 days (14.6%), 6-7 days (24%), and >7 days (61.4%). Overall treatment failure was uncommon (1.4%). In the primary comparison, failure occurred in 0.9% of 5-day courses versus 1.8% of 7-day courses (p=0.106). In the secondary, three-tier comparison, failure was 1.8% for 5 days, 1.8% for 6-7 days, and 1.1% for >7 days (p=0.069).

Conclusion(s): In otherwise healthy children aged 2-5 years with AOM, 5-day antibiotic courses performed similarly to 7-day courses with low failure rates. Findings support consideration of shorter courses aligning with outpatient antibiotic stewardship, while acknowledging the limitations inherent to retrospective analyses.

Figure 1. Overview of patient selection, inclusion, and exclusion.
Figure 1.pdf

Table 1. Demographic characteristics of the study population by treatment duration.
Table 1.pdf

Table 2. Treatment duration and treatment failure within 7 days of index visit (N=6389).
Table 2.pdf