What is the proper dose of amoxicillin (amoxicillin) liquid for a 7-year-old female patient weighing 62 pounds with acute otitis media?

From the Guidelines

For a seven-year-old female weighing 62 pounds (approximately 28 kg) with otitis media, the recommended dose of amoxicillin liquid is 90 mg/kg/day divided into two doses, as supported by the most recent and highest quality study 1. This translates to approximately 1,260 mg per day, or 630 mg twice daily. The typical concentration of amoxicillin suspension is 400 mg/5mL, so the child would need about 8 mL twice daily. Some key points to consider when treating otitis media with amoxicillin include:

• The standard duration of treatment for otitis media is 10 days, as indicated by various studies, including 1 and 1.
• It's essential to complete the full course of antibiotics even if symptoms improve before the medication is finished.
• The medication should be refrigerated after reconstitution and shaken well before each dose.
• High-dose amoxicillin is the first-line treatment for otitis media because it effectively targets Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which are the most common bacterial causes of ear infections, as noted in 1 and 1.
• If the child has a penicillin allergy or doesn't improve within 48-72 hours, contact a healthcare provider as an alternative antibiotic may be needed, as suggested by 1 and 1. Key considerations for amoxicillin dosing in children with otitis media include:
• Weight-based dosing, with a recommended dose of 90 mg/kg/day divided into two doses, as supported by 1.
• The importance of completing the full course of treatment, even if symptoms improve before the medication is finished, as emphasized by 1 and 1.
• The need for alternative antibiotics in cases of penicillin allergy or lack of improvement, as discussed in 1 and 1.

From the Research

Amoxicillin Dosage for Acute Otitis Media

• The recommended dosage of amoxicillin for a 7-year-old female patient weighing 62 pounds with acute otitis media is 75 to 90 mg/kg/day 2, 3.
• This dosage is based on studies that show the current amoxicillin dosing recommendation of 40 mg/kg/day is inadequate to effectively eradicate resistant Streptococcus pneumoniae, particularly during viral coinfection 2.
• A dosing regimen of 80-90 mg/kg/day is recommended as first-line therapy for acute otitis media in geographic areas where drug-resistant Streptococcus pneumoniae is prevalent 3, 4.

Considerations for Dosage

• The patient's weight and age should be taken into account when determining the dosage of amoxicillin 2, 3.
• The dosage may need to be adjusted based on the severity of the infection and the presence of any underlying medical conditions 3.
• High-dose amoxicillin (80-90 mg/kg/day) is still an appropriate choice as first-line empiric therapy for acute otitis media, followed by a beta-lactamase-stable drug in the event of failure 4.

Comparison of High-Dose and Standard-Dose Amoxicillin

• Studies have compared the efficacy and tolerability of high-dose versus standard-dose amoxicillin for acute otitis media 4, 5.
• One study found that high-dose amoxicillin had neither benefit nor detriment compared with standard-dose for acute otitis media in children at low risk for infection with antibiotic-resistant bacteria 5.
• Another study found that high-dose amoxicillin was effective in eradicating pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, but may not be effective against beta-lactamase-producing organisms 4.