From the Guidelines
Amoxicillin should be dosed at 80-90 mg/kg/day divided into two doses for the treatment of otitis media, as recommended by the most recent and highest quality study 1. The dosage of amoxicillin for otitis media is a crucial aspect of treatment, and the recommended dose is based on the patient's weight.
- The American Academy of Pediatrics recommends high-dose amoxicillin as the first-line treatment for most patients with otitis media 1.
- The recommended dose of amoxicillin is 80-90 mg/kg/day, divided into two doses, which is effective against common bacterial pathogens causing otitis media, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1.
- For patients with severe symptoms, recent antibiotic use within 30 days, or treatment failure, amoxicillin-clavulanate may be more appropriate as first-line therapy 1.
- Patients with penicillin allergy should receive an alternative antibiotic, and it's essential to complete the full course of antibiotics even if symptoms improve before completion.
- Symptomatic relief with analgesics like acetaminophen or ibuprofen is also recommended while waiting for the antibiotic to take effect. The most recent study 1 provides the highest quality evidence for the recommended dosage of amoxicillin for otitis media, and its findings should be prioritized in clinical practice.
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.