What is the recommended dose of amoxicillin (amoxicillin) capsules for a 10-year-old child weighing 124 pounds (56 kg) with otitis media?

Amoxicillin Dosing for Otitis Media in a 10-Year-Old Child Weighing 124 lbs (56 kg)

The recommended dose of amoxicillin for a 10-year-old child weighing 124 pounds (56 kg) with otitis media is 80-90 mg/kg/day, which equals 4,480-5,040 mg per day, divided into two or three doses. 1

Dosing Recommendations

• Amoxicillin is the first-line antibiotic treatment for acute otitis media (AOM) when antibiotics are indicated 1
• The recommended dosage is 80-90 mg/kg/day for children, which is considered "high-dose" amoxicillin 1
• For a 56 kg child, this equals approximately:
  • Total daily dose: 4,480-5,040 mg per day
  • If divided into twice daily dosing: 2,240-2,520 mg per dose
  • If divided into three times daily dosing: 1,493-1,680 mg per dose 1, 2

Rationale for High-Dose Amoxicillin

• High-dose amoxicillin (80-90 mg/kg/day) is recommended over standard-dose (40-45 mg/kg/day) due to increasing prevalence of penicillin-resistant Streptococcus pneumoniae 1, 2
• Studies have shown that high-dose amoxicillin achieves adequate middle ear fluid concentrations to overcome intermediate resistant pneumococci 2, 3
• The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guidelines specifically recommend this higher dosage to improve outcomes and reduce treatment failures 1

Duration of Therapy

• The recommended duration of treatment for AOM is typically 5-10 days 1
• For a 10-year-old child, a 5-7 day course is generally sufficient if symptoms improve 1

Treatment Considerations

• Assess for pain and provide appropriate pain management regardless of antibiotic use 1
• Consider amoxicillin-clavulanate instead of amoxicillin if the child:
  • Has received amoxicillin in the past 30 days
  • Has concurrent purulent conjunctivitis
  • Has a history of recurrent AOM unresponsive to amoxicillin 1, 4
• If the child has a penicillin allergy (non-type I hypersensitivity), alternative options include cefdinir, cefpodoxime, or cefuroxime 1

Monitoring and Follow-up

• Reassess the patient if symptoms worsen or fail to improve within 48-72 hours of starting treatment 1
• If treatment failure occurs, switch to an antibiotic with beta-lactamase coverage such as amoxicillin-clavulanate 1, 4

Common Pitfalls to Avoid

• Using standard-dose amoxicillin (40-45 mg/kg/day) may be inadequate for resistant organisms, particularly during viral co-infection 2, 3
• Failure to adjust dosing based on the child's actual weight can lead to underdosing and treatment failure 1, 2
• Not recognizing when to switch to a broader-spectrum antibiotic in cases of treatment failure 1
• Treating all cases of ear pain as bacterial AOM without proper diagnostic criteria (bulging tympanic membrane, middle ear effusion, signs of inflammation) 1