From the Guidelines
The recommended dose of amoxicillin for children with otitis media is 80-90 mg/kg/day divided into two doses, given for 5-10 days depending on the child's age and severity of infection. This high-dose regimen is preferred over the standard dose because it provides better coverage against resistant strains of Streptococcus pneumoniae, which is a common cause of otitis media 1. The medication should be given with food to reduce stomach upset. According to the American Academy of Pediatrics, high-dose amoxicillin is recommended as the first-line treatment in most patients 1.
- For children under 2 years old or those with severe symptoms, a 10-day course is typically recommended
- While children 2 years and older with mild to moderate symptoms may be treated with a 5-7 day course
- If the child shows no improvement after 48-72 hours of treatment, they should be reassessed as they may need a different antibiotic
- Common side effects include diarrhea, rash, and nausea
- It's essential to note that amoxicillin is contraindicated in children with known penicillin allergy In contrast to the World Health Organization's recommendation of 40 mg/kg/day for 5 days 1, the higher dose is supported by more recent evidence from the American Academy of Pediatrics 1.
From the Research
Amoxicillin Dose for Kids with Otitis Media
- The American Academy of Pediatrics recommends the use of high-dose amoxicillin for the treatment of acute uncomplicated otitis media (OM) 2.
- The recommended dose of amoxicillin is 80 to 90 mg/kg per day, which may exceed the standard adult dose of 1500 mg/d 2.
- A study found that primary care physicians often prescribe a lower-than-recommended dose of amoxicillin for older children and those in higher weight categories 2.
- Another study suggested that high-dose amoxicillin may not be necessary for children with acute otitis media if the local prevalence of nonsusceptible Streptococcus pneumoniae is low 3.
- The study recommended treating most children with uncomplicated acute otitis media with standard-dose amoxicillin, unless they attend child care or have recently received an antibiotic 3.
- A clinical trial found that high-dose amoxicillin had neither benefit nor detriment compared to standard-dose amoxicillin for acute otitis media in children at low risk for infection with antibiotic-resistant bacteria 4.
- A comparative study found that amoxicillin-clavulanate and azithromycin had similar clinical efficacy in treating acute otitis media in children 5.
- A pilot study suggested that once-a-day amoxicillin may be a feasible treatment option for acute otitis media, with similar efficacy to three divided doses daily 6.
Key Findings
- The recommended dose of amoxicillin for children with otitis media is 80 to 90 mg/kg per day 2, 3.
- High-dose amoxicillin may not be necessary for all children with acute otitis media 3, 4.
- Standard-dose amoxicillin may be sufficient for children at low risk for infection with antibiotic-resistant bacteria 4.
- Amoxicillin-clavulanate and azithromycin have similar clinical efficacy in treating acute otitis media in children 5.