From the Guidelines
For a 14-year-old weighing 45 kg with acute otitis media (AOM), I recommend amoxicillin 750-1000 mg orally twice daily for 5-7 days. This dosage is based on the standard recommendation of 80-90 mg/kg/day divided twice daily, with a maximum daily dose of 2000 mg, as suggested by 1. Since this patient is 45 kg, the calculated dose would be 1800-2000 mg daily, or 900-1000 mg twice daily. However, adult dosing can be used given the patient's weight exceeds 40 kg. The 5-7 day duration is appropriate for uncomplicated AOM in an adolescent. Some key points to consider when treating AOM include:
- Amoxicillin remains the first-line treatment for AOM due to its effectiveness against Streptococcus pneumoniae, the most common bacterial pathogen, as stated in 1 and 1.
- If the patient has taken antibiotics in the past 30 days, has concurrent purulent conjunctivitis, or has recurrent AOM, consider amoxicillin-clavulanate instead to cover beta-lactamase producing organisms, as recommended in 1.
- Ensure the patient completes the full course of antibiotics even if symptoms improve before completion. It's also important to note that the choice of antibiotic and duration of treatment may vary depending on the specific circumstances of the patient, such as allergy history or recent antibiotic use, as discussed in 1.
From the Research
Amoxicillin Dosage for Acute Otitis Media (AOM)
To determine the appropriate dose of amoxicillin for a 14-year-old patient weighing 45 kg with AOM, we can refer to the provided studies.
- The recommended dose of amoxicillin for AOM is either standard-dose (40-45 mg/kg/d) or high-dose (80-90 mg/kg/d) 2.
- For a patient weighing 45 kg, the standard-dose would be approximately 1800-2025 mg per day, and the high-dose would be approximately 3600-4050 mg per day.
- The studies do not provide a clear recommendation for the dose of amoxicillin based on the patient's weight, but they do suggest that high-dose amoxicillin may be more effective in eradicating bacterial pathogens 3.
- However, the study by 2 found that high-dose amoxicillin did not result in a greater incidence of adverse effects than standard-dose amoxicillin.
Comparison with Other Antibiotics
- Other studies compared the efficacy of amoxicillin with macrolide antibiotics, such as azithromycin and clarithromycin, in the treatment of AOM 4, 3, 5, 6.
- These studies found that amoxicillin was more effective than macrolide antibiotics in eradicating bacterial pathogens and achieving clinical success.
- However, the choice of antibiotic should be based on the patient's individual needs and medical history, as well as the severity of the infection.
Key Points
- The dose of amoxicillin for AOM can be either standard-dose (40-45 mg/kg/d) or high-dose (80-90 mg/kg/d) 2.
- Amoxicillin is more effective than macrolide antibiotics in eradicating bacterial pathogens and achieving clinical success 4, 3, 5, 6.
- The choice of antibiotic should be based on the patient's individual needs and medical history, as well as the severity of the infection.