Duration of Amoxicillin Treatment for Ear Infections
For acute otitis media (AOM), the recommended duration of amoxicillin treatment is 10 days for children under 2 years of age, 7 days for children 2-5 years with mild to moderate AOM, and 10 days for children 6 years and older. 1
Age-Based Treatment Duration
- For children younger than 2 years of age: A standard 10-day course of amoxicillin is recommended due to higher risk of treatment failure with shorter courses 1
- For children 2-5 years of age with mild or moderate AOM: A 7-day course of oral antibiotics appears to be equally effective 1
- For children 6 years and older with mild to moderate AOM: A standard 10-day course is recommended 1
Dosing Recommendations
- High-dose amoxicillin (80-90 mg/kg/day in 2 divided doses) is the first-line treatment for most patients with AOM 1, 2
- For children who have taken amoxicillin in the previous 30 days, those with concurrent purulent conjunctivitis, or those with recurrent AOM unresponsive to amoxicillin, amoxicillin-clavulanate should be used instead 1
Follow-Up Considerations
- Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 3
- If symptoms worsen or fail to respond to initial antibiotic treatment within 48 to 72 hours, the patient should be reassessed to determine whether a change in therapy is needed 1
Special Considerations
- Persistent middle ear effusion (MEE) is common after successful antibiotic treatment of AOM and does not require additional antibiotics 1
- Two weeks after successful antibiotic treatment, 60-70% of children still have MEE, decreasing to 40% at 1 month and 10-25% at 3 months 1
- The presence of MEE without clinical symptoms is defined as otitis media with effusion (OME) and requires monitoring but not antibiotic therapy 1
Treatment Efficacy Considerations
- Studies have shown that 5-day courses of antibiotics may be effective for uncomplicated ear infections in children over 2 years of age, with comparable outcomes to longer courses at 20-30 days follow-up 4
- However, the most recent guidelines still recommend the age-based approach outlined above to ensure optimal treatment outcomes, particularly for younger children 1
Pitfalls to Avoid
- Do not continue antibiotics unnecessarily for asymptomatic middle ear effusion after successful treatment of AOM 1
- Do not prescribe antibiotics for isolated redness of the tympanic membrane with normal landmarks, as this is not an indication for antibiotic therapy 1
- Ensure adequate visualization of the tympanic membrane before prescribing antibiotics, particularly in infants where examination can be difficult 1
- Reassess patients who fail to respond to initial therapy within 48-72 hours to determine if a change in treatment is needed 1