Amoxicillin Dosage for 2-Year-Old with Otitis Media
For a 2-year-old child weighing 36 pounds (16.3 kg) with otitis media, the recommended dosage is amoxicillin 45-90 mg/kg/day divided into two doses for 8-10 days, which equals approximately 5-9 mL of amoxicillin suspension (250 mg/5 mL) every 12 hours.
First-Line Treatment Selection
- Amoxicillin is the first-line antibiotic of choice for acute otitis media in children who have not received amoxicillin in the past 30 days, do not have concurrent purulent conjunctivitis, and are not allergic to penicillin 1
- For a child under 2 years of age with acute otitis media, antibiotic therapy is recommended rather than observation (Grade A recommendation) 1
Dosage Calculation
For standard dosing: 45 mg/kg/day divided into two doses 2
- 16.3 kg × 45 mg/kg/day = 733.5 mg/day
- 733.5 mg/day ÷ 2 doses = 367 mg per dose (approximately 7.3 mL of 250 mg/5 mL suspension) every 12 hours
For high-dose treatment (if in an area with high prevalence of penicillin-resistant S. pneumoniae): 90 mg/kg/day divided into two doses 2
- 16.3 kg × 90 mg/kg/day = 1,467 mg/day
- 1,467 mg/day ÷ 2 doses = 733.5 mg per dose (approximately 14.7 mL of 250 mg/5 mL suspension) every 12 hours
Treatment Duration
- For children under 2 years of age with acute otitis media, the recommended treatment duration is 8-10 days 1
- For children over 2 years, a shorter 5-day course may be sufficient, but since this child is exactly 2 years old and treatment success is critical, the longer duration is preferred 1
When to Consider Alternative Treatment
- If the child has received amoxicillin in the past 30 days, consider amoxicillin-clavulanate instead 1
- If the child has concurrent purulent conjunctivitis (suggesting H. influenzae infection), amoxicillin-clavulanate would be more appropriate 1
- For amoxicillin-clavulanate, the dosage would be 90/6.4 mg/kg/day of the amoxicillin component divided into two doses 3
Monitoring Response to Treatment
- Reassess the patient if symptoms worsen or fail to improve within 48-72 hours of starting antibiotics 1
- Treatment failure may require changing to a beta-lactamase stable antibiotic such as amoxicillin-clavulanate 4
- Failure of antibiotic therapy is defined as worsening of condition, persistence of symptoms beyond 48 hours of treatment, or recurrence within 4 days after treatment completion 1
Important Clinical Considerations
- Pain management is essential regardless of antibiotic therapy, as antibiotics do not provide symptomatic relief in the first 24 hours 1
- Beta-lactamase-producing organisms (particularly H. influenzae) are the predominant pathogens in children failing high-dose amoxicillin therapy 4
- For recurrent infections or treatment failures, referral to an ENT specialist may be necessary, especially if symptoms persist beyond 3 months 1