What is the recommended dose of amoxicillin (amoxicillin) for a child with acute otitis media?

From the Guidelines

The recommended dose of amoxicillin for a child with acute otitis media is 80-90 mg/kg/day divided into two doses for 5-7 days. This high-dose regimen is preferred over the standard dose due to increasing antibiotic resistance among common ear pathogens, as supported by the American Academy of Pediatrics and the American Academy of Family Physicians 1. For a specific child, the exact dose should be calculated based on their weight. The medication is typically given as an oral suspension, with common concentrations being 250 mg/5 mL or 400 mg/5 mL.

• Key considerations for amoxicillin dosing include:
  • Weight-based dosing to ensure adequate coverage
  • Duration of treatment, typically 5-7 days
  • Potential for resistance, particularly in children who have taken amoxicillin in the past 30 days or have concurrent purulent conjunctivitis
• Alternative treatments, such as amoxicillin-clavulanate, may be necessary in cases of potential resistance or penicillin allergy, as outlined in the Pediatrics journal 1.
• It's essential to note that the World Health Organization pocket book of hospital care recommends a dose of 40 mg/kg BD for 5 days for acute otitis media 1, but this may not be sufficient due to increasing antibiotic resistance.
• Parents should complete the full course of antibiotics even if symptoms improve before completion, and the high-dose amoxicillin is effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

From the FDA Drug Label

Based on the amoxicillin component, amoxicillin and clavulanate potassium should be dosed as follows: Patients Aged 12 weeks (3 months) and Older: Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTION | DOSING REGIMEN Otitis media | 45 mg/kg/day every 12 hours

The 250 mg/125 mg amoxicillin and clavulanate potassium tablets should not be used until the child weighs at least 40 kg, due to the different amoxicillin to clavulanic acid ratios in the 250 mg/125 mg amoxicillin and clavulanate potassium tablets (250/125) versus the 250 mg/62.5 mg amoxicillin and clavulanate potassium tablets (Chewable).

For a child with acute otitis media who is 7 years old, the recommended dose of amoxicillin is 45 mg/kg/day every 12 hours 2.

• The dose is based on the amoxicillin component.
• The every 12 hours regimen is recommended as it is associated with significantly less diarrhea.
• The duration of therapy studied and recommended for acute otitis media is 10 days. Note: The child's weight is not provided, so the exact dose in milligrams cannot be calculated.

From the Research

Amoxicillin Dosage for Acute Otitis Media

The recommended dose of amoxicillin for a child with acute otitis media (AOM) is a topic of discussion among medical professionals.

• According to a study published in 1998 3, the current amoxicillin dosing recommendation of 40 mg/kg/day in three divided doses is inadequate to effectively eradicate resistant Streptococcus pneumoniae, particularly during viral coinfection.
• A dosing regimen of 75 to 90 mg/kg/day is recommended for AOM.
• Another study published in 2002 4 suggests that amoxicillin at conventional or high doses (80-90 mg/kg/day) remains an appropriate choice for first-line therapy for AOM.
• However, a study published in 2004 5 found that high-dose amoxicillin (80-90 mg/kg/d) did not have a significant benefit over standard-dose amoxicillin (40-45 mg/kg/d) in treating children with AOM who were at low risk for infection with antibiotic-resistant bacteria.
• More recent studies, such as one published in 2023 6, suggest that amoxicillin-clavulanate should be the treatment of choice for children between 6 months and 12 years of age with AOM.

Considerations for Dosage

When considering the dosage of amoxicillin for a 7-year-old child with AOM, the following factors should be taken into account:

• The severity of the infection
• The presence of resistant bacteria
• The child's weight and age
• The potential for side effects, such as diarrhea, which was found to be more common in children treated with amoxicillin/clavulanate than with cefdinir 7
• The American Academy of Pediatrics recommends a dose of 80-90 mg/kg/day of amoxicillin for the treatment of AOM, which is supported by studies such as 3 and 4.