From the Guidelines
For a 2-year-old child with otitis media, the recommended dose of Augmentin (amoxicillin/clavulanate) is typically 90 mg/kg/day of the amoxicillin component, divided into two doses given every 12 hours for 10 days, as recommended by the most recent and highest quality study 1. This usually means using the Augmentin ES (extra strength) formulation which contains 600 mg amoxicillin and 42.9 mg clavulanate per 5 mL. The exact dose should be calculated based on the child's weight. For example, a 12 kg child would need approximately 1080 mg of amoxicillin daily, or 540 mg (4.5 mL of ES formulation) twice daily. It's essential to complete the full course of antibiotics even if symptoms improve before the medication is finished. The medication should be given with food to reduce stomach upset. The high dose is recommended because some strains of bacteria causing otitis media have developed partial resistance to amoxicillin, and the higher concentration helps overcome this resistance, as noted in the study 1. The clavulanate component inhibits beta-lactamase enzymes that some bacteria produce to resist the antibiotic. Parents should be advised to watch for side effects including diarrhea, diaper rash, and allergic reactions. Key considerations for treatment include:
- The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present, with amoxicillin being recommended as first-line therapy for AOM 1.
- The optimal duration of therapy for patients with AOM is uncertain, but 10 days is commonly recommended 1.
- Alternative treatments, such as cefdinir, cefpodoxime, or cefuroxime, may be considered in patients with a history of penicillin allergy, but the risk of cross-reactivity is lower than historically reported 1.
From the Research
Recommended Dose of Augmentin for a 2-year-old with Otitis Media
The recommended dose of Augmentin (amoxicillin/clavulanate) for a 2-year-old with otitis media can be determined based on the following evidence:
- The conventional formulation of amoxicillin/clavulanic acid is typically administered at a dose of 40/10 mg/kg/day in three divided doses 2.
- A high-dose formulation of amoxicillin/clavulanic acid, known as Augmentin ES-600, is administered at a dose of 90/6.4 mg/kg/day in two divided doses 2, 3.
- Studies have shown that twice-daily administration of amoxicillin/clavulanic acid is effective and well-tolerated in the treatment of acute otitis media in children 4, 5.
- The twice-daily regimen has been shown to have a lower incidence of diarrhea compared to the three-times-daily regimen 4, 5.
Key Points to Consider
- The choice of dose and formulation should be based on the severity of the infection and the presence of risk factors for resistant pathogens.
- The high-dose formulation (Augmentin ES-600) may be considered for recurrent or persistent acute otitis media where involvement of resistant pathogens is suspected 2, 3.
- The twice-daily regimen may be preferred due to its convenience and lower incidence of diarrhea 4, 5.