Treatment of otitis media with once-daily amoxicillin - Tips from Other Journals

Date: Feb 1, 1994

Because of poor compliance with current treatment schedules for acute otitis media, a move toward the simplification of antibiotic dosing schedules has been advocated. Previously, once-daily regimens have been largely confined to third-generation cephalosporins, which have a prolonged half-life. Murph and colleagues conducted a prospective, double-blind, placebo-controlled study to evaluate the effectiveness and rate of side effects of once-daily dosing of amoxicillin in the treatment of acute otitis media.

Children between seven months and 12 years of age with a diagnosis of acute otitis media were recruited from a university clinic. A total of 77 children were randomly assigned to one of two groups. Children in the first group received one dose of amoxicillin suspension (40 mg per kg) and two doses of placebo each day for 10 days. Children in the second group received three daily doses of amoxicillin suspension (13 1/3 mg per kg, for a total daily dose of 40 mg per kg), over the 10-day period. All of the children received a single dose of amoxicillin 13% mg per kg) at the time of enrollment. Parents completed a daily record of signs and symptoms of infection or antibiotic effect. Children were evaluated by pneumatic otoscopy and impedance tympanometry 10 and 14 days after enrollment.

During the study, 10 children were lost to follow-up. Among the 67 children who completed the study, no differences existed between the groups in terms of age, sex or average number of previous ear infections. Also, the two groups did not differ with respect to symptoms, including fever, vomiting, diarrhea, earache, sore throat, poor feeding or other upper respiratory infections as described by parents at presentation.

Otoscopic and tympanometric findings of middle ear effusion were in concordance in 108 (93 percent) of 116 ears evaluated by both methods after the treatment period. Middle ear infection had resolved in 27 (82 percent) of the children who received once-daily amoxicillin, compared with 23 children (68 percent) who received amoxicillin three times daily. All of the 67 children received at least 80 percent of the medication prescribed.

The two groups did not differ in the number of children whose otitis media resolved and those who continued to have tympanometric evidence of persistent middle ear fluid. Significantly fewer children who received amoxicillin once a day continued to complain of ear pain after the third day of antibiotic treatment. Also, the total number of complaints of diarrhea, vomiting or stomach pain did not differ between the two groups.

The authors conclude that once-daily administration of amoxicillin is as effective as the traditional three-times-per-day dosage in the treatment of acute otitis media. Adverse reactions to the antibiotic are not increased in children who receive their entire daily dose at one time. The authors propose that increased compliance with a simplified dosing schedule may offer improved outcomes. (Clinical Pediatrics, September 1993, vol. 32, p. 528.)

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