What is the recommended daily dose of amoxicillin (antibiotic) for a pediatric patient weighing 16kg with an ear infection?

Amoxicillin Dosage for Pediatric Ear Infection

For a 16kg child with an ear infection, the recommended daily dose of amoxicillin is 80-90 mg/kg/day divided into two doses, which equals 1280-1440 mg per day (640-720 mg twice daily). 1

Dosage Calculation and Rationale

• High-dose amoxicillin (80-90 mg/kg/day divided twice daily) is the first-line treatment for acute otitis media (AOM) to overcome resistant strains of Streptococcus pneumoniae 1
• For a 16kg child, this calculates to approximately 1280-1440 mg total daily dose 1, 2
• The medication should be administered in two divided doses (640-720 mg twice daily) 1, 3
• Treatment should be continued for 10 days to prevent complications, especially for infections caused by Streptococcus pyogenes 2

Clinical Considerations

• High-dose amoxicillin is recommended over standard dose (40 mg/kg/day) because it achieves middle ear fluid levels that exceed the minimum inhibitory concentration (MIC) of intermediately resistant S. pneumoniae and many highly resistant serotypes 1
• High-dose amoxicillin has been shown to improve bacteriologic and clinical efficacy compared with regular dose regimens 1
• The medication should be taken at the start of a meal to minimize gastrointestinal intolerance 2

Special Circumstances Requiring Amoxicillin-Clavulanate

Consider switching to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) in these situations:

• If the child has taken amoxicillin in the previous 30 days 1
• If the child has concurrent conjunctivitis 1
• When coverage for β-lactamase-producing H. influenzae and M. catarrhalis is desired 1

Administration Considerations

• Twice-daily dosing is as effective as three-times-daily dosing and may improve medication compliance 3
• The suspension should be shaken well before using and can be refrigerated (though not required) 2
• Any unused portion must be discarded after 14 days 2

Common Pitfalls to Avoid

• Underdosing is a common error in pediatric prescribing; ensure accurate weight-based calculations 4
• Using standard-dose amoxicillin (40 mg/kg/day) may be inadequate for resistant S. pneumoniae, particularly during viral coinfection 5
• Failure to complete the full course of antibiotics may lead to treatment failure and potential resistance 4
• Not considering amoxicillin-clavulanate when there's recent amoxicillin use or concurrent conjunctivitis 1