When it comes to treating otitis media in children, longer is better, according to a new study. Researchers designed a trial to determine if five days of amoxicillin-clavulanate was non-inferior to 10 days, with the assumption that a shorter course would reduce the risk of antibiotic resistance. Researchers assigned 520 children 6-23 months of age with acute otitis media for a standard duration of 10 days or a reduced duration of five days followed by placebo for 5 days. The clinical failure rate was 34% in the shorter duration group vs. 16% for standard duration (95% confidence interval, 9-25). The mean symptom scores also were higher in the shorter duration group. There was no difference in adverse events or nasopharyngeal colonization with penicillin- nonsusceptible pathogens. The authors concluded that reduced-duration antimicrobial treatment resulted in less favorable outcomes than standard-duration treatment. Additionally, neither the rate of adverse events nor the rate of emergence of antimicrobial resistance was lower with the shorter regimen (N Engl J Med 2016;375:2446-2456).