From the Guidelines
For otitis media, the recommended dosing of amoxicillin is 80-90 mg/kg/day divided into two doses. This dosing is based on the most recent and highest quality study, which recommends high-dose amoxicillin as the first-line treatment for most patients 1. The justification for this dosing is due to amoxicillin's effectiveness against common bacterial pathogens, safety, low cost, acceptable taste, and narrow microbiologic spectrum.
Key Considerations
- The dosing of 80-90 mg/kg/day is recommended for children, with the medication divided into two doses 1.
- For patients who have taken amoxicillin in the previous 30 days, those with concurrent conjunctivitis, or those for whom coverage for Moraxella catarrhalis is desired, therapy should be initiated with high-dose amoxicillin-clavulanate 1.
- Alternative treatments are available for patients with penicillin allergy, including cefdinir, cefuroxime, and cefpodoxime, which are highly unlikely to be associated with cross-reactivity with penicillin allergy 1.
Important Notes
- It is essential to complete the full course of antibiotics, even if symptoms improve before completion, to prevent recurrence and antibiotic resistance.
- The optimal duration of therapy for patients with otitis media is uncertain, but a 5-7 day course is commonly recommended.
- In areas with high prevalence of penicillin-resistant Streptococcus pneumoniae, the higher end of the dosing range may be preferred.
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 or 40 mg/kg/day every 8 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).
The recommended dosing of amoxicillin for otitis media is:
- 45 mg/kg/day every 12 hours or
- 40 mg/kg/day every 8 hours 2. Duration of therapy for acute otitis media is 10 days 2.
From the Research
Amoxicillin Dosing for Otitis Media
- The recommended dosing of amoxicillin for otitis media can vary depending on the specific circumstances of the patient and the prevalence of resistant bacteria in the community 3.
- A study published in 2013 found that once or twice daily doses of amoxicillin, with or without clavulanate, were comparable to three or four times daily doses in terms of effectiveness for treating acute otitis media in children 4.
- Another study published in 2004 suggested that high-dose amoxicillin (80-90 mg/kg per day) may not be necessary for treating uncomplicated acute otitis media in children if the local prevalence of nonsusceptible Streptococcus pneumoniae is low 3.
- A study published in 2003 found that high-dose amoxicillin (70-90 mg/kg per day) was effective in treating acute otitis media in children, with a bacteriologic eradication rate of 83% for all pathogens 5.
- Comparisons with other antibiotics, such as azithromycin, have shown that amoxicillin/clavulanate can be effective in treating acute otitis media, but may have a higher rate of side effects and relapses compared to azithromycin 6, 7.
Key Findings
- Once or twice daily doses of amoxicillin may be as effective as three or four times daily doses for treating acute otitis media in children 4.
- High-dose amoxicillin may not be necessary for treating uncomplicated acute otitis media in children if the local prevalence of nonsusceptible Streptococcus pneumoniae is low 3.
- Amoxicillin/clavulanate can be effective in treating acute otitis media, but may have a higher rate of side effects and relapses compared to azithromycin 6, 7.