From the Guidelines
For a 6-month-old child with bilateral otitis media, the recommended dosage of amoxicillin is 80-90 mg/kg/day divided into two doses for 10 days, as this high-dose regimen is preferred over the standard dose due to its better penetration into the middle ear fluid and effectiveness against resistant strains of Streptococcus pneumoniae 1. The exact dose should be calculated based on the child's weight. For example, if the child weighs 8 kg, they would need approximately 320-360 mg twice daily. Some key points to consider when administering amoxicillin to a 6-month-old child with bilateral otitis media include:
- Amoxicillin should be given with or without food, and the liquid formulation should be refrigerated after reconstitution 1.
- Parents should complete the full course even if symptoms improve before 10 days.
- If the child develops a rash, severe diarrhea, or shows no improvement after 48-72 hours, they should contact their healthcare provider as this may indicate either an allergic reaction or the need for a different antibiotic 1.
- Supportive care with acetaminophen or ibuprofen can help manage pain and fever during treatment. It's also important to note that the dosage recommendations may vary depending on the specific circumstances, such as the child's medical history and the severity of the infection. However, the recommended dosage of 80-90 mg/kg/day divided into two doses for 10 days is the most commonly recommended regimen for a 6-month-old child with bilateral otitis media, as stated in the study published in Pediatrics 1. In contrast, a study published in the British Journal of Pharmacology in 2015 recommends a dosage of 40 mg/kg/day for 5 days for acute otitis media 1, but this is not the most recent or highest quality study for this specific condition. Therefore, the recommendation from the Pediatrics study 1 should be prioritized.
From the Research
Recommended Dosing for Amoxicillin in a 6-Month-Old Child with Bilateral Otitis Media
The recommended dosing for amoxicillin in a 6-month-old child with bilateral otitis media is as follows:
- A dosing regimen of 75 to 90 mg/kg/day is recommended for acute otitis media (AOM) 2
- High dose amoxicillin (80 mg/kg/day three times a day for 10 days) has been shown to be effective in treating AOM in children 3
- Amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses for 10 days has also been shown to be highly efficacious in children with AOM, including those with penicillin-resistant Streptococcus pneumoniae (PRSP) 4
Key Considerations
- The current amoxicillin dosing recommendation of 40 mg/kg/day in three divided doses may be inadequate to effectively eradicate resistant Streptococcus pneumoniae, particularly during viral coinfection 2
- High dose amoxicillin is still an appropriate choice as first line empiric therapy for AOM, followed by a beta-lactamase-stable drug in the event of failure 3
- The choice of antibiotic and dosing regimen should be based on the specific needs of the child and the severity of the infection