What is the recommended amoxicillin (amoxicillin) dosage for a 12-year-old patient with acute otitis media who can swallow pills?

From the Guidelines

For a 12-year-old patient with acute otitis media who can swallow pills, the recommended amoxicillin dosage is 80-90 mg/kg/day divided into two doses, as stated in the most recent guideline 1. This dosage is based on the American Academy of Pediatrics (AAP) recommendation, which suggests that high-dose amoxicillin is the first-line treatment for most patients with acute otitis media. The standard course of treatment is typically 5-7 days, but the exact duration may vary depending on the severity of symptoms and the patient's response to treatment. Some key points to consider when treating acute otitis media with amoxicillin include:

• The higher dose range (80-90 mg/kg/day) is preferred in areas with high prevalence of resistant pneumococci or if the child has severe symptoms, recent antibiotic use, or treatment failure with standard dosing 1.
• Amoxicillin is effective against Streptococcus pneumoniae, the most common bacterial pathogen in ear infections, and has a narrow microbiologic spectrum, making it a safe and effective choice for treatment 1.
• It's essential to complete the full course of antibiotics, even if symptoms improve before finishing, to ensure that the infection is fully cleared and to reduce the risk of antibiotic resistance.
• If the patient shows no improvement after 48-72 hours, has worsening symptoms, or develops side effects like severe diarrhea or rash, they should be reassessed by a healthcare provider 1.
• Adequate pain management with acetaminophen or ibuprofen should also be provided as needed to help manage symptoms and improve the patient's quality of life.

From the FDA Drug Label

Patients Aged 12 weeks (3 months) and Older: See dosing regimens provided in Table 1. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTION DOSING REGIMEN Every 12 hours Every 8 hours 200 mg/5 mL or 400 mg/5 mL oral suspensiona 125 mg/5 mL or 250 mg/5 mL oral suspensiona Otitis mediab, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours 40 mg/kg/day every 8 hours Less severe infections 25 mg/kg/day every 12 hours 20 mg/kg/day every 8 hours Patients Weighing 40 kg or More: Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations

For a 12-year-old patient with acute otitis media who can swallow pills, the recommended dosage of amoxicillin is based on the patient's weight.

• If the patient weighs 40 kg or more, the dosage is according to adult recommendations:
  • Severe infections: 875 mg every 12 hours or 500 mg every 8 hours
  • Less severe infections: 500 mg every 12 hours or 250 mg every 8 hours
• If the patient weighs less than 40 kg, the dosage is based on the pediatric dosing regimen:
  • Otitis media, sinusitis, lower respiratory tract infections, and more severe infections: 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours
  • Less severe infections: 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours Since the patient's weight is not specified, the exact dosage cannot be determined. However, the dosage should be based on the patient's weight and the severity of the infection, as outlined in the dosing regimens provided in Table 1 2.

From the Research

Amoxicillin Dosage for Acute Otitis Media

• The recommended dosage of amoxicillin for acute otitis media (AOM) in children is typically based on the severity of the infection and the patient's weight 3.
• For a 12-year-old patient who can swallow pills, the dosage may vary depending on the specific formulation and the prescriber's preference.
• Studies have shown that once or twice daily doses of amoxicillin can be as effective as three or four times daily doses for the treatment of AOM in children 4, 5.
• The American Academy of Pediatrics recommends a dosage of 80-90 mg/kg/day of amoxicillin for the treatment of AOM in children, with a maximum daily dose of 1000-1500 mg 3.
• However, some studies have found that standard-dose amoxicillin (40-45 mg/kg/day) may be just as effective as high-dose amoxicillin (80-90 mg/kg/day) for children at low risk for infection with antibiotic-resistant bacteria 3.
• The choice of dosage and formulation should be based on the individual patient's needs and medical history, as well as the prescriber's clinical judgment.

Key Considerations

• The patient's weight and age should be taken into account when determining the dosage of amoxicillin 4, 3.
• The severity of the infection and the presence of any underlying medical conditions should also be considered when selecting a dosage regimen 6, 7.
• The patient's ability to swallow pills and the availability of different formulations (e.g. liquid, tablet) should also be taken into account when selecting a treatment regimen 4, 5.