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Comparison of amoxicillin administered twice and three times daily in children with acute otitis media

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Abstract

To compare the effectiveness of amoxicillin administered in regimens of two or three daily doses in children with acute otitis media (AOM). As a secondary aim, we measured and compared treatment adherence between the two groups.

A prospective observational study was conducted in the emergency department of a children’s hospital.

We recruited a total of 353 patients having a median age of 1.58 years. Twice-daily dosing was prescribed to 58%, while 42% received three doses per day. The clinical course of AOM was favourable in 92% of the patients who received two doses of amoxicillin and in 95% of those who received three doses (p = 0.25). Four patients (1%) had persistent symptoms beyond day 7. None developed intracranial complications. In the group receiving three doses daily, 31% reported difficulties with the dosing schedule, and 9.6% faced challenges when administering the medication at the specified volume, compared with 5.8% and 25% of those who received the two-dose regimen, respectively.

  Conclusion: Twice-daily amoxicillin has similar efficacy to a three-dose daily regimen and can offer advantages for caregivers in terms of administration schedule.

What is Known:

• Amoxicillin given in two daily doses is as effective as a three doses regimen in the treatment of acute otitis media in children.

• The lower the number of daily doses, the higher the adherence to a drug treatment.

What is New:

• Administration of amoxicillin in twice-daily doses may improve adherence, as it is less frequently associated with family-perceived problems with dosing schedules.

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Abbreviations

AOM:

Acute otitis media

ED:

Emergency department

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Authors and Affiliations

  1. Emergency Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain

    Pilar Storch-De-Gracia

  2. Instituto de Investigación Sanitaria La Princesa, Madrid, Spain

    Pilar Storch-De-Gracia

  3. Hospital Infantil Universitario Niño Jesús, Madrid, Spain

    Valeria Antoñanzas-Bernar, Beatriz Vergara-Muñoz, Nuria Lamagrande-Casanova, Marianna Di Campli-Zaghlul, María Suárez-Bustamante, Juan Añón-Hidalgo & Miguel Maiques

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  1. Pilar Storch-De-Gracia
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  2. Valeria Antoñanzas-Bernar
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  3. Beatriz Vergara-Muñoz
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  4. Nuria Lamagrande-Casanova
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  8. Miguel Maiques
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Contributions

Mariana Di Campli-Zaghlul, María Suárez-Bustamante, Juan Añón-Hidalgo and Miguel Maiques contributed to the study conception and design and data collection. Material preparation and analysis were performed by Pilar Storch-De-Gracia. Data collection and first draft of the manuscript was written by Valeria Antoñanzas- Bernar, Beatriz Vergara-Muñoz and Nuria Lamagrande-Casanova, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Pilar Storch-De-Gracia.

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The authors declare no competing interests.

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Communicated by Tobias Tenenbaum

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Storch-De-Gracia, P., Antoñanzas-Bernar, V., Vergara-Muñoz, B. et al. Comparison of amoxicillin administered twice and three times daily in children with acute otitis media. Eur J Pediatr 182, 5599–5605 (2023). https://doi.org/10.1007/s00431-023-05243-2

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  • DOI: https://doi.org/10.1007/s00431-023-05243-2

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