Less is More: The Evidence for Shorter Durations of Antimicrobial Therapy for Acute Otitis Media

Acute otitis media (AOM) is a common pediatric infection and a large reason for antibiotic prescribing in pediatrics in the United States. The changing epidemiology, high spontaneous resolution rate, and low complication rate of AOM has challenged the traditional management of longer durations of antibiotics. In this review, we discuss the evidence supporting shorter durations of antibiotic therapy and delayed prescribing for pediatric AOM.

The incidence and epidemiology of AOM has changed significantly since the introduction of the pneumococcal conjugate vaccine. Most AOM cases resolve spontaneously, and when antibiotics are necessary, shorter treatment durations (5 days) are safe and effective while minimizing adverse antibiotic effects and combating antibiotic resistance. Evidence-based guidelines increasingly recommend initial observation or delayed prescribing for non-severe AOM, which has reduced antibiotic use without compromising outcomes. Additionally, rates of complications of AOM are similar regardless of antibiotic use.

AOM remains a common pediatric infection, driving substantial antibiotic use and healthcare costs. However, most children with AOM do not benefit from antibiotics. Current evidence supports the safety and efficacy of initial observation and short antibiotic courses when treatment is necessary. Implementing multi-faceted strategies can improve AOM management, reduce unnecessary antibiotic use, and mitigate antibiotic resistance.