From the Guidelines
For a 12-year-old girl with acute otitis media, the recommended dose of amoxicillin is 90 mg/kg/day divided into two doses (given every 12 hours), with a maximum of 3000 mg daily. This high-dose regimen is preferred over standard dosing because it better addresses resistant strains of Streptococcus pneumoniae, a common cause of ear infections, as supported by the American Academy of Pediatrics guidelines 1. For most 12-year-old girls, this would typically mean 750-1000 mg twice daily for 10 days.
Key Considerations
- The dosage is based on the patient's weight, with a recommended dose of 80 to 90 mg per kg per day, as stated in the AAP and AAFP guideline 1.
- If the child has taken antibiotics in the past 30 days, has concurrent purulent conjunctivitis, or has recurrent otitis media that hasn't responded to amoxicillin, amoxicillin-clavulanate may be preferred instead at a similar dosage, as recommended by the Pediatrics guidelines 1.
- It's essential to complete the full course of antibiotics even if symptoms improve within a few days.
- Pain management with acetaminophen or ibuprofen is also recommended.
- If symptoms worsen or don't improve after 48-72 hours of treatment, the child should be reevaluated as a different antibiotic may be needed, according to the Pediatrics guidelines 1.
Alternative Treatment Options
- For patients allergic to amoxicillin, alternative treatment options include cefdinir, cefpodoxime, or cefuroxime, as stated in the AAP and AAFP guideline 1.
- The choice of alternative treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present, as recommended by the Pediatrics guidelines 1.
From the Research
Recommended Dose of Amoxicillin for Acute Otitis Media (AOM)
The recommended dose of amoxicillin for a 12-year-old female patient with acute otitis media (AOM) is as follows:
- High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) is recommended for the treatment of AOM 2
- Amoxicillin/clavulanate (90/6.4 mg/kg/d) is also recommended for persistent or recurrent AOM 2
- The dose of amoxicillin can be given twice daily, as studies have shown that once or twice daily doses of amoxicillin are comparable to three times daily doses in terms of efficacy and safety 3, 4
Considerations for Treatment
When treating AOM, the following considerations should be taken into account:
- The patient's age and weight should be considered when determining the dose of amoxicillin
- The patient's medical history and any allergies or sensitivities should be considered when selecting an antibiotic
- The potential for antibiotic resistance should be considered when selecting an antibiotic, and pharmacokinetic/pharmacodynamic principles should be taken into account 5
- The use of a beta-lactamase inhibitor such as clavulanate may be necessary to cover infection with beta-lactamase-producing pathogens 2