What is the recommended dose of amoxicillin (amoxicillin) for a 2-year-old child weighing 20 kg with otitis media?

From the Guidelines

For a 2-year-old child weighing 20 kg with otitis media, the recommended dose of amoxicillin is 40 mg/kg/day divided into two doses, which equals approximately 400 mg twice daily for a total of 800 mg per day, as per the guidelines from the World Health Organization 1.

Key Considerations

• The typical duration of treatment is 5 days for acute otitis media, as suggested by the World Health Organization guidelines 1.
• Amoxicillin should be given with or without food, though taking it with food may help reduce stomach upset.
• The medication comes in various forms including oral suspension (liquid), which is often preferred for young children.
• It's essential to complete the full course of antibiotics even if symptoms improve before the medication is finished.

Rationale

• Amoxicillin is the first-line treatment for otitis media due to its effectiveness against Streptococcus pneumoniae, the most common bacterial cause of ear infections.
• If the child has taken amoxicillin in the past 30 days or has concurrent purulent conjunctivitis, amoxicillin-clavulanate might be preferred instead due to concerns about resistant bacteria, as noted in other guidelines 1.

Additional Guidance

• The dose of amoxicillin may vary depending on the severity of the infection and the presence of other health conditions.
• It's crucial to follow the prescribed dosage and treatment duration to ensure effective treatment and minimize the risk of antibiotic resistance.
• Regular follow-up with a healthcare provider is necessary to monitor the child's response to treatment and adjust the treatment plan as needed.

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 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

For a 2-year-old child weighing 20 kg with otitis media, the recommended dose of amoxicillin is:

• Mild/Moderate: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
• Severe: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours So for this child:
• Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours
• Severe: 900 mg every 12 hours or 800 mg every 8 hours 2

From the Research

Amoxicillin Dosage for Otitis Media in a 2-Year-Old Child Weighing 20 kg

The recommended dose of amoxicillin for a 2-year-old child weighing 20 kg with otitis media can be determined based on the following studies:

• A study published in 1998 3 found that 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, and recommends a dosing regimen of 75 to 90 mg/kg/day.
• Another study from 2003 4 evaluated the bacteriologic and clinical efficacy of high-dose amoxicillin (80 mg/kg/day) as first-line therapy in acute otitis media and found that eradication was achieved in 82% of patients for 83% of pathogens.
• A 2004 study 5 compared the efficacy and tolerability of high-dose (80-90 mg/kg/d) versus standard-dose (40-45 mg/kg/d) amoxicillin among children with acute otitis media and found that high-dose amoxicillin had neither benefit nor detriment compared with standard-dose for AOM in children at low risk for infection with antibiotic-resistant bacteria.

Key Points to Consider

• The American Academy of Pediatrics recommends a dose of 80-90 mg/kg/day of amoxicillin for the treatment of acute otitis media in children, which is higher than the traditional dose of 40-45 mg/kg/day.
• The choice of dose may depend on the severity of the infection, the presence of resistant organisms, and the child's individual needs.
• It is essential to consult with a healthcare professional to determine the most appropriate dose and treatment plan for a child with otitis media.

Dosage Calculation

Based on the recommended dose of 80-90 mg/kg/day, the calculated dose for a 20 kg child would be:

• 80 mg/kg/day: 20 kg x 80 mg/kg = 1600 mg/day, divided into 3-4 doses
• 90 mg/kg/day: 20 kg x 90 mg/kg = 1800 mg/day, divided into 3-4 doses

It is crucial to follow the specific dosage instructions provided by a healthcare professional and to complete the full course of treatment as prescribed.