Is Amoxicillin (amoxicillin) 500mg bid appropriate for a 15-year-old girl with right ear acute otitis media (AOM) and no fever?

From the Guidelines

Amoxicillin 500mg bid is not an appropriate treatment for a 15-year-old girl with right ear acute otitis media (AOM) and no fever, as the recommended dosage is 80 to 90 mg per kg per day, which would be higher than 500mg bid for most adolescents. The recommended regimen is:

• Amoxicillin 80 to 90 mg per kg per day, which can be divided into 2 doses, for 5-7 days 1 Additional guidance:
• Complete the full course of antibiotics even if symptoms improve
• Use over-the-counter pain relievers like acetaminophen or ibuprofen for pain relief if needed
• Apply a warm compress to the ear for comfort
• Follow up if symptoms worsen or do not improve after 48-72 hours According to the most recent and highest quality study, high-dose amoxicillin is recommended as the first-line treatment in most patients with AOM, with a dosage of 80 to 90 mg per kg per day 1. Key considerations for treatment include:
• Effectiveness against common bacterial causes like Streptococcus pneumoniae and Haemophilus influenzae
• Safety, low cost, acceptable taste, and narrow microbiologic spectrum
• Potential for cross-reactivity with penicillin allergy, although this risk is lower than historically reported, especially with second- and third-generation cephalosporins 1.

From the FDA Drug Label

Table 1 (12 weeks) n 40 kg Recommended Dosage for Pediatric Patients Aged 3 Months and Older and Weight Less than 40 kg Ear/Nose/Throat Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours

The recommended dosage for a pediatric patient with Ear/Nose/Throat infection, specifically Mild/Moderate acute otitis media (AOM), is 500 mg every 12 hours or 250 mg every 8 hours. Since the patient is 15 years old, she is considered an adult in terms of dosing, and the recommended dose for adults is the same as for pediatric patients over 40 kg. Therefore, amoxicillin 500mg bid is an appropriate dose for a 15-year-old girl with right ear acute otitis media (AOM) and no fever, assuming she has no other underlying conditions that may affect the dosing, such as renal impairment 2.

From the Research

Amoxicillin Dosage for Acute Otitis Media (AOM)

• The recommended dosage of amoxicillin for AOM is 75 to 90 mg/kg/day 3, which is higher than the conventional dose of 40 mg/kg/day.
• A study found that the current amoxicillin dosing recommendation of 40 mg/kg/day is inadequate to effectively eradicate resistant Streptococcus pneumoniae, particularly during viral coinfection 3.
• The American Academy of Pediatrics recommends amoxicillin as the first-line treatment for AOM, with a dosage of 80-90 mg/kg/day 4.

Treatment of AOM in Children

• Acute otitis media is a common illness during childhood, and antibiotics are frequently prescribed 5, 6.
• The effect of antibiotics in AOM depends on the chosen outcome, but has been shown to reduce pain somewhat, and have a greater beneficial effect in severe cases of AOM 5.
• A study found that short-course antibiotics (less than seven days) have a higher risk of treatment failure compared to long-course antibiotics (seven days or more) 6.

Specific Considerations for the 15-year-old Girl

• The patient's age and lack of fever may be relevant factors in determining the appropriate treatment for AOM 7.
• A study found that older age (24-35 months) and peaked tympanogram at entry decreased the hazard for treatment failure, suggesting that older children may be more likely to recover without antimicrobial treatment 7.
• However, the patient's specific condition, including the presence of right ear AOM and no fever, would need to be evaluated by a healthcare professional to determine the most appropriate treatment course.

Amoxicillin 500mg bid for AOM

• The dosage of amoxicillin 500mg bid (twice a day) is approximately 25-30 mg/kg/day for a 15-year-old girl, assuming a weight of 40-50 kg.
• This dosage is lower than the recommended dosage of 75 to 90 mg/kg/day for AOM 3.
• Therefore, amoxicillin 500mg bid may not be an appropriate dosage for the treatment of AOM in this patient, and a higher dosage may be necessary to effectively eradicate the infection 3, 4.