What is an appropriate duration of antimicrobial therapy for AOM?

Five days of antimicrobial treatment with amoxicillin or second-generation cephalosporins are at least as effective as 10 days of therapy in children older than two years of age with uncomplicated AOM (56,57). Do some children warrant a 10-day course of therapy for AOM? Ten-day antimicrobial treatment courses are appropriate for children younger than two years of age, children with frequent recurrent AOM or otitis media with perforated tympanic membrane, and in children who failed their initial antimicrobial, because these children are at increased risk of treatment failure (exceptions to this rule are azithromycin for which a five-day course is the maximum, and ceftriaxone for which one dose is usually given for uncomplicated cases and three doses for cases that failed initial therapy) (58-65).

The benefit of the longer course may partly come from the child being in a ‘prophylaxed’ state should he or she develop a new upper respiratory tract infection within 10 days of AOM diagnosis. ... more.

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