Amoxicillin Prescription for Pediatric Ear Infection
For a child with an ear infection requiring 1280-1440 mg of amoxicillin per day with a medication concentration of 400mg/5mL, the prescription should read: "Amoxicillin 400mg/5mL oral suspension: 8-9 teaspoons (40-45 mL) daily divided into 2-3 doses for 10 days." 1, 2
Dosing Calculation
- For pediatric ear infections, amoxicillin is the first-line treatment due to its effectiveness against susceptible and intermediate-resistant pneumococci, safety profile, and acceptable taste 1, 3
- The recommended dosage for amoxicillin in children with ear infections is 40-90 mg/kg/day divided into 2-3 doses 1
- With a medication concentration of 400mg/5mL:
- For 1280 mg daily: 1280mg ÷ 400mg/5mL = 16mL per day (approximately 3 teaspoons per dose if given 3 times daily, or 4 teaspoons per dose if given twice daily) 2
- For 1440 mg daily: 1440mg ÷ 400mg/5mL = 18mL per day (approximately 3 teaspoons per dose if given 3 times daily, or 4.5 teaspoons per dose if given twice daily) 2
Dosing Frequency Considerations
- Twice-daily dosing of amoxicillin has been shown to be as effective as three-times-daily dosing for acute otitis media, which may improve medication compliance 4
- The FDA-approved amoxicillin suspension can be administered in either 2 or 3 divided doses per day 2
- For ear infections, a 10-day course of therapy is recommended to ensure complete eradication of the organism and prevent complications 5, 3
Important Clinical Considerations
- Higher dosing of amoxicillin (75-90 mg/kg/day) is recommended for acute otitis media, particularly in areas with high pneumococcal resistance or when viral coinfection is present 6
- The full 10-day course of amoxicillin should be completed even if symptoms resolve earlier to prevent treatment failure and complications 5
- Clinical improvement should be expected within 24-48 hours of starting treatment 5
- Common adverse effects include gastrointestinal disturbances such as diarrhea, nausea, and vomiting 1
- Amoxicillin is primarily excreted unchanged in the urine, with approximately 60% of an orally administered dose excreted within 6-8 hours 2
Prescription Writing Best Practices
- The prescription should include: the daily dose, the number of divided doses, the duration of therapy, the indication for the prescription, and the child's weight 7
- For clarity, both teaspoons and milliliters should be specified to avoid dosing errors 2
- If the child is under 2 years of age or has a complicated or symptomatic form of purulent acute otitis media, antibiotic treatment is strongly indicated 3