What is the recommended dose of amoxicillin (amoxicillin) for a child with otitis media weighing 32 pounds (#)?

Amoxicillin Dosing for Otitis Media in a 32-Pound Child

For a 32-pound (14.5 kg) child with otitis media, the recommended dose of amoxicillin is 80-90 mg/kg/day divided in two doses, which equals approximately 1160-1305 mg total daily dose or 580-652 mg twice daily. 1, 2

Dosing Calculation

• Child's weight: 32 pounds = 14.5 kg
• Recommended dose: 80-90 mg/kg/day
• Total daily dose: 14.5 kg × 80-90 mg/kg = 1160-1305 mg/day
• Divided into 2 doses: 580-652 mg per dose, given twice daily

Rationale for High-Dose Amoxicillin

• High-dose amoxicillin (80-90 mg/kg/day) is the first-line treatment for acute otitis media according to the American Academy of Pediatrics 1, 2
• This dosing is effective against common pathogens including susceptible and intermediately resistant Streptococcus pneumoniae 1
• Standard-dose amoxicillin (40-45 mg/kg/day) is inadequate to effectively eradicate resistant S. pneumoniae, particularly during viral coinfection 3

Special Considerations

• If the child has taken amoxicillin in the previous 30 days, has concurrent conjunctivitis, or requires coverage for β-lactamase-producing H. influenzae and M. catarrhalis, consider high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses) 1, 2
• Duration of therapy studied and recommended for acute otitis media is 10 days 4
• Twice-daily dosing has been shown to be as effective as three-times-daily dosing, with significantly less diarrhea 4, 5

Alternative Options for Penicillin Allergy

If the child has a non-type I penicillin allergy, alternative treatments include:

• Cefdinir (14 mg/kg/day in 1-2 doses)
• Cefuroxime (30 mg/kg/day in 2 doses)
• Cefpodoxime (10 mg/kg/day in 2 doses) 1, 2

Pain Management

• Address pain management regardless of antibiotic use
• Acetaminophen or ibuprofen can be used for pain relief 1, 2

Follow-up Recommendations

• Reassess within 48-72 hours if symptoms worsen or fail to improve
• If no improvement after 48-72 hours of amoxicillin, switch to amoxicillin-clavulanate or consider ceftriaxone 1, 2

Common Pitfalls to Avoid

1. Underdosing: Using standard-dose amoxicillin (40-45 mg/kg/day) may be inadequate for resistant organisms 3
2. Ignoring recent antibiotic use: Children who have received amoxicillin in the past 30 days should receive amoxicillin-clavulanate instead 1, 2
3. Overlooking pain management: Pain relief should be addressed regardless of antibiotic use 1, 2
4. Inappropriate dosing frequency: Twice-daily dosing is as effective as three-times-daily dosing and improves compliance 5
5. Exceeding adult maximum dose: For heavier children, some clinicians cap the dose at the standard adult maximum of 1500 mg/day, though guidelines don't specifically address this 6

Remember that middle ear effusion commonly persists after resolution of acute symptoms (60-70% at 2 weeks, 40% at 1 month) and does not require additional antibiotics 2.