From the Guidelines
For a 6-year-old child with acute otitis media (AOM), the recommended amoxicillin dosage is 80-90 mg/kg/day divided into two doses (given every 12 hours) 1. The maximum daily dose should not exceed 3000 mg per day. For a typical 6-year-old weighing approximately 20 kg, this would mean about 800-900 mg twice daily. Treatment duration should be 10 days for optimal clearance of the infection, especially in children under 6 years of age. If the child has risk factors for resistant organisms (recent antibiotic use, treatment failure, or daycare attendance), consider amoxicillin-clavulanate instead, using the same amoxicillin dosage but with added clavulanic acid 1. The high dose of amoxicillin is recommended because Streptococcus pneumoniae, a common cause of AOM, can have intermediate resistance to penicillins, and higher concentrations are needed to overcome this resistance. Some key points to consider when treating AOM include:
- The choice of a first-line treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present 1.
- Amoxicillin is recommended as first-line therapy for AOM because it is generally effective when used in sufficient doses against susceptible and intermediate resistant pneumococci 1.
- Monitor for side effects such as diarrhea and rash.
- Ensure the child completes the full course of antibiotics even if symptoms improve within a few days to prevent recurrence and antibiotic resistance. It's also important to note that for penicillin-allergic children, recent data suggest that cross-reactivity among penicillins and cephalosporins is lower than historically reported 1. Some alternative treatments for penicillin-allergic children include cefdinir, cefuroxime, and cefpodoxime 1.
From the Research
Maximum Dose of Amoxicillin for Acute Otitis Media (AOM) in a 6-year-old Child
- The maximum dose of amoxicillin for AOM in children is recommended to be 80-90 mg/kg/d, divided into two or three doses per day 2, 3, 4.
- This high-dose regimen is recommended due to the increasing prevalence of drug-resistant Streptococcus pneumoniae and beta-lactamase-producing pathogens 2, 3, 4.
- Studies have shown that high-dose amoxicillin is effective in eradicating pathogens, including S. pneumoniae and Haemophilus influenzae, in children with AOM 3, 5.
- However, one study found that high-dose amoxicillin did not have a significant benefit over standard-dose amoxicillin in children at low risk for infection with antibiotic-resistant bacteria 6.
- The American Academy of Pediatrics recommends high-dose amoxicillin (80-90 mg/kg/d) as the first-line treatment for AOM in children, with the option to switch to a different antibiotic if the child does not respond to treatment 2, 4.
Calculation of Maximum Dose for a 6-year-old Child
- To calculate the maximum dose of amoxicillin for a 6-year-old child, the child's weight in kilograms must be known.
- Assuming an average weight of 20-25 kg for a 6-year-old child, the maximum dose would be:
- 80 mg/kg/d: 80 mg/kg/d x 20-25 kg = 1600-2000 mg/d
- 90 mg/kg/d: 90 mg/kg/d x 20-25 kg = 1800-2250 mg/d
- The dose should be divided into two or three doses per day, depending on the specific regimen recommended by the healthcare provider 2, 3, 4.