From the Guidelines
For a 47-pound (approximately 21 kg) child with otitis media, the recommended dose of amoxicillin is 90 mg/kg/day divided into two doses, as stated in the 2013 Pediatrics guideline 1. This would be approximately 1890 mg per day, which translates to about 945 mg twice daily. Standard amoxicillin formulations for children include liquid suspensions of 250 mg/5 mL or 400 mg/5 mL. Using the 400 mg/5 mL suspension, the child would need about 11.8 mL twice daily, but to make it easier, this can be rounded to approximately 12 mL twice daily. The typical duration of treatment for otitis media is 10 days, as generally recommended for this condition. It's essential to complete the full course of antibiotics even if symptoms improve before the medication is finished. High-dose amoxicillin is the first-line treatment for acute otitis media because it effectively targets Streptococcus pneumoniae, the most common bacterial cause of ear infections, including resistant strains, as supported by the American Academy of Pediatrics and the American Academy of Family Physicians 1. Some key points to consider when treating otitis media include:
- The importance of choosing the right antibiotic and dosage to effectively target the causative bacteria
- The need to complete the full course of treatment to prevent recurrence and reduce the risk of antibiotic resistance
- Monitoring for potential side effects, such as diarrhea, rash, or nausea, and seeking medical attention if the child does not improve within 48-72 hours or if severe reactions occur. If the child has a penicillin allergy or doesn't improve within 48-72 hours, it's crucial to contact a healthcare provider as an alternative antibiotic may be needed, with options including cefdinir, cefuroxime, or cefpodoxime, as outlined in the 2013 Pediatrics guideline 1.
From the Research
Amoxicillin Dosage for Otitis Media in a 47-Pound Child
To determine the appropriate dose of amoxicillin for a 47-pound child with otitis media, we need to consider the recommended dosage based on weight.
- The standard dose of amoxicillin for acute otitis media is 40-45 mg/kg/d 2.
- The high-dose amoxicillin regimen is 80-90 mg/kg/d 2.
- For a 47-pound (21.3 kg) child, the standard dose would be approximately 853-959 mg per day, and the high-dose would be approximately 1706-1917 mg per day.
Considerations for Treatment
When deciding on the treatment for otitis media, it's essential to consider the efficacy and safety of different antibiotics.
- Amoxicillin is a commonly recommended antibiotic for the treatment of otitis media 2, 3.
- Macrolide antibiotics, such as clarithromycin and azithromycin, may be used as alternatives, but they have been associated with a higher risk of clinical failure 3.
- The choice of antibiotic and dosage should be based on the specific needs of the patient and the severity of the infection.
Clinical Evidence
Studies have compared the efficacy of amoxicillin with other antibiotics in the treatment of otitis media.
- A study comparing high-dose and standard-dose amoxicillin found no significant difference in treatment success or adverse effects 2.
- Another study found that macrolide antibiotics were associated with an increased risk of clinical failure compared to amoxicillin or amoxicillin/clavulanate 3.
- A study comparing azithromycin and amoxicillin for the prevention of recurrent acute otitis media found that both treatments were effective, but azithromycin had a similar clinical response to amoxicillin 4.