What is the dose of amoxicillin (antibiotic) for acute otitis media (AOM) and acute otitis externa (AOE) in a 33-pound (approximately 15 kilograms) child?

Amoxicillin Dosing for Acute Otitis Media and Acute Otitis Externa in a 33-pound Child

For acute otitis media (AOM) in a 33-pound (15 kg) child, the recommended dose of amoxicillin is 80-90 mg/kg/day, which equals 1200-1350 mg/day divided into 2-3 doses. 1

Acute Otitis Media (AOM) Treatment

Dosing Recommendations:

• First-line therapy: Amoxicillin 80-90 mg/kg/day 1
  • For a 15 kg child: 1200-1350 mg/day
  • Can be divided into twice daily or three times daily dosing 2, 3
  • Typical duration: 5-10 days (5 days for children >2 years, 8-10 days for children <2 years) 1

Decision Algorithm for AOM Treatment:

1. Confirm diagnosis using criteria:

   • History of acute onset of signs/symptoms
   • Presence of middle-ear effusion
   • Signs of middle-ear inflammation 1

2. Assess need for antibiotics:

   • For children <6 months: Always treat with antibiotics
   • For children 6 months-2 years: Treat if diagnosis is certain OR symptoms are severe
   • For children >2 years: Observation is an option for non-severe cases 1

3. Treatment approach:

   • Initial therapy: High-dose amoxicillin (80-90 mg/kg/day)
   • If penicillin allergy (non-type I): Consider cefdinir, cefpodoxime, or cefuroxime 1
   • If treatment failure after 48-72 hours: Reassess and consider changing antibiotics 1

Important Clinical Considerations:

• Pain management should always be addressed regardless of antibiotic use 1
• Recent studies show that twice-daily dosing of amoxicillin is as effective as three-times daily dosing and may improve adherence 2, 3
• Higher dosing (80-90 mg/kg/day) is recommended due to increasing prevalence of resistant pneumococci 4, 5

Acute Otitis Externa (AOE) Treatment

For acute otitis externa, amoxicillin is NOT the recommended treatment. AOE is typically treated with topical antimicrobial preparations rather than oral antibiotics.

Treatment Approach for AOE:

• Topical antibiotic preparations are the standard of care
• Oral antibiotics like amoxicillin are not indicated unless there is extension beyond the ear canal or in immunocompromised patients
• Treatment focuses on:
  • Cleaning the ear canal
  • Topical antimicrobial/anti-inflammatory preparations
  • Pain management

Common Pitfalls to Avoid:

• Do not underdose amoxicillin: Standard dose (40-45 mg/kg/day) may be inadequate for resistant organisms 4
• Do not use amoxicillin for AOE: Topical therapy is preferred
• Do not continue ineffective therapy: If no improvement after 48-72 hours, reassess and change antibiotics 1
• Do not overlook pain management: Pain control is essential regardless of antibiotic use 1

Weight-Based Dosing Calculation:

For a 33-pound (15 kg) child with AOM:

• At 80 mg/kg/day: 15 kg × 80 mg = 1200 mg/day
• At 90 mg/kg/day: 15 kg × 90 mg = 1350 mg/day
• Can be divided into 2 doses (600-675 mg twice daily) or 3 doses (400-450 mg three times daily)