What is the dose, frequency, and duration of amoxicillin (amoxicillin) for a 1-year-old male with bilateral otitis media, weighing 10.8 kg, with no prior antibiotics in the last month?

From the Guidelines

For a 1-year-old male weighing 10.8 kg with bilateral otitis media and no prior antibiotic use in the last month, the recommended treatment is amoxicillin at a dose of 80-90 mg/kg per day, divided into 2 doses, for a duration of 10 days, as this regimen has been shown to be effective against common ear pathogens, including Streptococcus pneumoniae, while minimizing the risk of resistance and side effects 1. The dosage is based on the most recent and highest quality evidence, which recommends high-dose amoxicillin as the first-line treatment for acute otitis media in children, due to its effectiveness, safety, and narrow microbiologic spectrum 1. To calculate the dose, we can use the recommended dosage of 80-90 mg/kg per day, which for a 10.8 kg child would be:

• 80 mg/kg per day: 80 mg/kg * 10.8 kg = 864 mg per day, divided into 2 doses of approximately 432 mg every 12 hours
• 90 mg/kg per day: 90 mg/kg * 10.8 kg = 972 mg per day, divided into 2 doses of approximately 486 mg every 12 hours Given the child's weight and the recommended dosage, the total daily dose would be between 864 mg and 972 mg, divided into 2 doses, which is higher than the previously suggested 500 mg per day, highlighting the importance of using the most recent guidelines for treatment 1. It is crucial to complete the full 10-day course of antibiotics, even if symptoms improve before the end of the treatment, to prevent recurrence and the development of antibiotic-resistant bacteria 1. Common side effects of amoxicillin include diarrhea and rash, and parents should be advised to seek medical attention if the child develops severe diarrhea, worsening ear pain after 48-72 hours, persistent fever, or shows signs of an allergic reaction 1.

From the Research

Dose, Frequency, and Duration of Amoxicillin for Bilateral Otitis Media

• The recommended dose of amoxicillin for a 1-year-old male with bilateral otitis media is 90 mg/kg/day, divided into three doses 2.
• For a child weighing 10.8 kg, the total daily dose would be 90 mg/kg/day * 10.8 kg = 972 mg/day.
• The frequency of amoxicillin administration is typically three times a day 2.
• The recommended duration of amoxicillin therapy for acute otitis media is 5 days 2, although some studies suggest that 10-day courses are still commonly prescribed 3.
• It is essential to note that the American Academy of Pediatrics recommends a 10-day course of amoxicillin for children under 2 years of age with bilateral otitis media, but a 5-day course may be considered for children over 2 years of age with uncomplicated acute otitis media 4, 5.

Considerations for Antibiotic Therapy

• Amoxicillin is an appropriate choice for first-line therapy for acute otitis media, especially in children with no prior antibiotics in the last month 4, 5.
• The high prevalence of drug-resistant S. pneumoniae and beta-lactamase-producing organisms presents a clinical challenge for practitioners in the selection of empiric antimicrobial therapy 4.
• Pharmacokinetic/pharmacodynamic principles should be considered in addition to minimum inhibitory concentrations in selecting antibiotics for acute otitis media 4.