What is the recommended dose of amoxicillin (amoxicillin) for an 18-month-old child with otitis media weighing 44 pounds?

Amoxicillin Dosing for Otitis Media in 18-Month-Old Child Weighing 44 Pounds

For an 18-month-old child weighing 44 pounds (20 kg) with otitis media, the recommended dose of amoxicillin is 80-90 mg/kg/day in 2 divided doses, which equals 1600-1800 mg per day or 800-900 mg per dose twice daily. 1, 2

Dosing Calculation

• The American Academy of Pediatrics recommends high-dose amoxicillin (80-90 mg/kg/day) as first-line treatment for acute otitis media 1
• For a child weighing 44 pounds (20 kg):
  • Total daily dose: 20 kg × 80-90 mg/kg = 1600-1800 mg/day 2
  • Divided into twice daily dosing: 800-900 mg every 12 hours 1, 2

Rationale for High-Dose Amoxicillin

• High-dose amoxicillin is recommended over standard-dose (40-45 mg/kg/day) due to increasing prevalence of penicillin-resistant Streptococcus pneumoniae 2, 3
• The higher dosage improves eradication of resistant pneumococci while maintaining an excellent safety profile 1, 3
• Studies have shown that high-dose amoxicillin achieves 92% eradication of S. pneumoniae, including penicillin-nonsusceptible strains 3

Duration of Therapy

• The recommended duration of treatment for acute otitis media is typically 10 days for children under 2 years of age 1
• This duration is particularly important for young children (18 months) to ensure complete eradication of pathogens 2

Alternative Treatment Considerations

• If the child has received amoxicillin in the previous 30 days, consider amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses) 1
• For children with penicillin allergy, alternatives include:
  • Cefdinir (14 mg/kg/day in 1-2 doses)
  • Cefuroxime (30 mg/kg/day in 2 divided doses)
  • Cefpodoxime (10 mg/kg/day in 2 divided doses) 1

Monitoring and Follow-up

• Reassess the child if symptoms worsen or fail to improve within 48-72 hours of starting treatment 1
• If treatment failure occurs with amoxicillin, switch to amoxicillin-clavulanate at the dose mentioned above 1

Common Pitfalls to Avoid

• Underdosing amoxicillin can lead to treatment failure, especially in areas with high prevalence of resistant pneumococci 4, 3
• Not recognizing when to switch to a broader-spectrum antibiotic in cases of treatment failure or when the child has recently received amoxicillin 1
• Using standard-dose amoxicillin (40-45 mg/kg/day) may be inadequate for eradicating resistant S. pneumoniae, particularly during viral coinfection 4

Efficacy and Safety Considerations

• Studies have shown that high-dose amoxicillin has excellent efficacy against common otitis media pathogens while maintaining a favorable safety profile 3
• The twice-daily dosing regimen is associated with significantly less diarrhea compared to three-times-daily dosing, improving compliance 5