What is the recommended dose of amoxicillin (amoxicillin) for treating ear infections?

Recommended Amoxicillin Dosage for Ear Infections

For treating acute otitis media (ear infections), amoxicillin should be prescribed at a dosage of 80-90 mg/kg/day divided into two doses. 1

Dosing Guidelines Based on Patient Age

Children over 3 months of age:

• First-line treatment: High-dose amoxicillin 80-90 mg/kg/day divided into two doses 1
• Duration:
  • Children under 2 years: 8-10 days 1
  • Children 2 years and older: 5 days 1

Children under 3 months of age:

• Maximum dose: 30 mg/kg/day divided every 12 hours 2
• This lower dose is due to incompletely developed renal function affecting amoxicillin elimination 2

Clinical Decision Algorithm

1. Confirm diagnosis of acute otitis media (AOM):

   • Distinct erythema of the tympanic membrane
   • Signs of middle ear inflammation
   • Presence of middle ear effusion
   • Otorrhea (if present)

2. Determine treatment approach based on age:

   • Children under 2 years: Antibiotic therapy recommended 1
   • Children over 2 years: Observation option possible unless severe symptoms present 1

3. Select appropriate antibiotic:

   • Standard case: High-dose amoxicillin (80-90 mg/kg/day divided twice daily) 1
   • If concurrent conjunctivitis or recent amoxicillin use (within 30 days): Amoxicillin-clavulanate 1
   • If penicillin allergy (non-type I): Cefdinir, cefpodoxime, or cefuroxime 1

4. Assess response:

   • Patient should stabilize within 24 hours and begin improving within 48 hours
   • If no improvement after 48-72 hours, reassess diagnosis and change antibiotic 1

Important Clinical Considerations

• The higher dose (80-90 mg/kg/day) is recommended to overcome intermediate-resistant pneumococcal strains 1

• Amoxicillin is preferred as first-line therapy because it is:

  • Effective against common pathogens
  • Safe
  • Inexpensive
  • Has an acceptable taste
  • Has a narrow microbiologic spectrum 1

• To minimize gastrointestinal intolerance, amoxicillin should be taken at the start of a meal 2

Common Pitfalls to Avoid

1. Underdosing: Using the standard 40 mg/kg/day dose is inadequate for resistant Streptococcus pneumoniae, particularly during viral coinfection 3

2. Inappropriate observation: While observation without antibiotics is an option for selected children, this should be limited to:

   • Otherwise healthy children 6 months to 2 years with non-severe illness and uncertain diagnosis
   • Children 2 years or older without severe symptoms 1

3. Inadequate follow-up: If choosing observation, ensure follow-up within 48-72 hours 1

4. Failure to reassess: If the patient fails to respond within 48-72 hours, the diagnosis should be confirmed and antibiotics changed if necessary 1

5. Treating isolated redness of tympanic membrane: This alone is not an indication for antibiotic therapy 1

While some studies have explored once-daily dosing 4, 5, 6, the current guidelines still recommend divided doses to maintain adequate drug levels throughout the treatment period.