What is the recommended dose of Amoxicillin (Amox) for a teenager with an ear infection?

From the Guidelines

The recommended dose of amoxicillin for a teenager with an ear infection is 80-90 mg/kg per day in 2 divided doses, as stated in the Pediatrics journal study from 2013 1. This dose is recommended as the first-line treatment for acute otitis media, and it's essential to complete the full course of antibiotics even if symptoms improve before the medication is finished.

• The medication should be taken with or without food, though taking it with food may help reduce stomach upset.
• Common side effects may include diarrhea, stomach upset, or rash.
• If the teenager has a penicillin allergy, an alternative antibiotic such as cefdinir, cefuroxime, or cefpodoxime would be needed instead, as they are highly unlikely to be associated with cross-reactivity with penicillin 1.
• Another study from 2015 1 recommends a dose of 40 mg/kg twice daily for 5 days for acute otitis media, but this study is less recent and not as specific to the treatment of ear infections in teenagers as the 2013 study.
• It's crucial to note that the dose of amoxicillin may vary depending on the severity of the infection and the individual patient's needs, and a healthcare provider should be consulted to determine the best course of treatment.
• Adequate hydration should be maintained while taking the medication, and the teenager should contact a healthcare provider if symptoms worsen or do not improve after 2-3 days of treatment.

From the FDA Drug Label

Table 1 Patients Aged 3 Months (12 Weeks) and Older

Infection Severity	Recommended Dosage for Adult and Pediatrics Patients Aged 3 Months and Older and Weight Greater than 40 kg	Recommended Dosage for Pediatric Patient Aged 3 Months and Older and Weight Less than 40 kg
Ear/Nose/Throat	500 mg every 12 hours or 250 mg every 8 hours	25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours

For a teenager with an ear infection, the recommended dose of Amoxicillin is:

• 500 mg every 12 hours or
• 250 mg every 8 hours if the patient weighs more than 40 kg 2. If the patient weighs less than 40 kg, the dose is 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours. It is essential to consult a healthcare professional to determine the appropriate dose based on the individual's weight and the severity of the infection.

From the Research

Amoxicillin Dosage for Teenagers with Ear Infections

• The recommended dose of Amoxicillin for teenagers with ear infections is not explicitly stated in the provided studies, as they primarily focus on children. However, the studies suggest that the dosage for children can be used as a reference.
• A study from 1998 3 recommends a dosing regimen of 75 to 90 mg/kg/day for acute otitis media (AOM) in children, as the current recommendation of 40 mg/kg/day may be inadequate to effectively eradicate resistant Streptococcus pneumoniae.
• Another study from 2021 4 does not provide specific dosage recommendations for teenagers but mentions that children received prescriptions as randomised, with some receiving immediate oral amoxicillin.
• A study from 1996 5 compared once-weekly azithromycin with once-daily amoxicillin (20 mg/kg) for the prevention of recurrent AOM in children, but does not provide information on teenagers.
• A review from 2008 6 compared once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of AOM in children, but did not find sufficient evidence to judge the effectiveness of different dosing regimens.
• A study from 1986 7 found that amoxicillin twice daily (60 mg/kg per day) was comparable to a thrice-daily regimen in the treatment of AOM in infants and children, with no significant difference in efficacy or adverse side effects.

Considerations for Teenagers

• While the studies do not provide specific dosage recommendations for teenagers, it is essential to consider the individual's weight, age, and medical history when determining the appropriate dose.
• The dosage recommended for children may be used as a reference, but it is crucial to consult a healthcare professional for personalized advice.
• The studies highlight the importance of compliance with antibiotic administration, and a simplified dosing regimen may improve adherence to treatment.