What is the recommended dosage of Amoxicillin (amoxicillin) for an adult with acute otitis media?

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Last updated: May 9, 2025 • View editorial policy

From the Guidelines

For adults with otitis media, the recommended amoxicillin dosage is 80 to 90 mg per kg per day, as this option is based on extrapolation from microbiologic studies and expert opinion, with preponderance of benefit over risk 1. To determine the appropriate dosage, the patient's weight in kilograms should be considered.

  • The dosage can be divided into two or three doses per day, depending on the patient's preference and tolerance.
  • It is essential to note that the optimal duration of therapy for patients with AOM is uncertain, but typically ranges from 5-7 days.
  • Amoxicillin is recommended as first-line therapy for AOM because it is generally effective when used in sufficient doses against susceptible and intermediate resistant pneumococci, and it also is safe, inexpensive, and has an acceptable taste and narrow microbiologic spectrum 1.
  • If the patient is allergic to amoxicillin, alternative antibiotics such as cefdinir, cefpodoxime, or cefuroxime can be prescribed, but this should be done with caution and under the guidance of a healthcare professional.
  • Patients should complete the entire course of antibiotics even if symptoms improve before finishing, and supportive measures including pain management with acetaminophen or ibuprofen are also recommended alongside antibiotic therapy.

From the Research

Amoxicillin Dosage for Adults with Otitis Media

  • The recommended dosage of amoxicillin for adults with otitis media is not explicitly stated in the provided studies, as they primarily focus on pediatric patients.
  • However, one study 2 mentions that high-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) is the drug of choice for treatment of acute otitis media, but this dosage is likely intended for pediatric patients.
  • For adults, the dosage of amoxicillin may vary depending on the severity of the infection and other factors, but a common dosage range is not specified in the provided studies.

Comparison of Dosage Frequencies

  • Some studies 3, 4 compare the effectiveness of once or twice daily doses of amoxicillin with three or four daily doses for the treatment of acute otitis media in children.
  • These studies suggest that once or twice daily doses may be comparable to three or four daily doses in terms of clinical cure rates and adverse events, but the evidence is not conclusive.
  • It is unclear whether these findings can be applied to adults with otitis media, as the studies primarily focus on pediatric patients.

Alternative Antibiotics

  • Some studies 5, 6 evaluate the efficacy of alternative antibiotics, such as clarithromycin, for the treatment of acute otitis media.
  • These studies suggest that clarithromycin may be effective in treating otitis media caused by certain strains of bacteria, but the findings are not directly applicable to amoxicillin dosage for adults.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.