From the Guidelines
For a 10-year-old boy weighing 60 kg with acute otitis media, the recommended dose of amoxicillin is 90 mg/kg/day divided into two doses, not to exceed the adult maximum dose of 1000 mg twice daily, as stated in the 2013 Pediatrics guideline 1. Given his weight, this child should receive 1000 mg (1 gram) of amoxicillin twice daily. The optimal duration of therapy is uncertain, but a common recommendation is 5-7 days, although this is not explicitly stated in the provided guidelines. The medication should be taken with or without food at evenly spaced intervals, approximately every 12 hours. It's essential to complete the full course of antibiotics even if symptoms improve before the medication is finished. Amoxicillin is the first-line treatment for acute otitis media because it effectively targets Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which are the most common bacterial pathogens in ear infections, as noted in the 2004 American Family Physician guideline 1. The high dose (90 mg/kg/day) is recommended to overcome potential resistance, particularly from penicillin-resistant Streptococcus pneumoniae. Some key points to consider when treating acute otitis media include:
- The choice of a first-line treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present 1.
- If the child has taken amoxicillin in the past 30 days, has concurrent purulent conjunctivitis, or has recurrent otitis media that is unresponsive to amoxicillin, an alternative such as amoxicillin-clavulanate might be more appropriate, as suggested in the 2013 Pediatrics guideline 1.
- For penicillin-allergic children, recent data suggest that cross-reactivity among penicillins and cephalosporins is lower than historically reported, and cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin 1.
From the FDA Drug Label
One U.S./Canadian clinical trial was conducted which compared 45/6. 4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media. The clinical efficacy rates at the end of therapy visit (defined as 2 to 4 days after the completion of therapy) and at the follow-up visit (defined as 22 to 28 days post-completion of therapy) were comparable for the 2 treatment groups, with the following cure rates obtained for the evaluable patients: At end of therapy, 87% (n = 265) and 82% (n = 260) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively. At follow-up, 67% (n = 249) and 69% (n = 243) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively.
The recommended daily dose of amoxicillin for a 10-year-old boy weighing 60 kg with acute otitis media is 45 mg/kg/day divided every 12 hours, which translates to approximately 1350 mg every 12 hours, or 40 mg/kg/day divided every 8 hours, which translates to approximately 1200 mg every 8 hours. The recommended duration of treatment is 10 days 2.
From the Research
Recommended Daily Dose of Amoxicillin
- The recommended daily dose of amoxicillin for a 10-year-old boy weighing 60 kg with acute otitis media is 80-90 mg/kg/day, as stated in the study 3.
- This dose is also supported by another study 4, which recommends high-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) as the drug of choice for treatment of acute otitis media.
Duration of Amoxicillin Treatment
- The duration of amoxicillin treatment for acute otitis media is typically 10 days, as mentioned in the study 5.
- However, the study 6 compared the efficacy of high-dose versus standard-dose amoxicillin for acute otitis media and found that high-dose amoxicillin did not result in a greater incidence of adverse effects than standard-dose amoxicillin, but it did not provide a specific recommendation for the duration of treatment.
Considerations for Treatment
- The choice of antibiotic and duration of treatment should be based on the severity of the infection, the patient's age and weight, and the presence of any underlying medical conditions, as discussed in the study 7.
- Amoxicillin-clavulanate is considered a suitable treatment option for children with acute otitis media, as it has been shown to be effective in eradicating Streptococcus pneumoniae from the culture, as mentioned in the study 7.