Amoxicillin Dosage for 6-Year-Old with Ear Infection
For a 6-year-old child with acute otitis media, prescribe high-dose amoxicillin at 80-90 mg/kg/day divided into 2 doses daily for 10 days. 1, 2
Standard First-Line Dosing
- High-dose amoxicillin (80-90 mg/kg/day in 2 divided doses) is the recommended first-line treatment for most children with acute otitis media, including 6-year-olds 1, 2
- This dosing achieves middle ear fluid concentrations that exceed the minimum inhibitory concentration (MIC) for intermediately resistant Streptococcus pneumoniae and many highly resistant serotypes 1, 2
- High-dose amoxicillin is effective against the three major bacterial pathogens: S. pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1, 3
Treatment Duration
- Treat for a full 10-day course in children 6 years and older with mild to moderate acute otitis media 1
- While 7-day courses may be adequate for children 2-5 years old with mild/moderate disease, the standard 10-day duration is recommended for 6-year-olds 1
When to Use Amoxicillin-Clavulanate Instead
Switch to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses) if: 1, 2, 3
- The child received amoxicillin within the previous 30 days
- Concurrent purulent conjunctivitis is present
- Coverage for β-lactamase-producing H. influenzae or M. catarrhalis is specifically needed
The 14:1 ratio formulation (amoxicillin to clavulanate) causes less diarrhea than other preparations 1, 3
Treatment Failure Protocol
- Reassess at 48-72 hours if no clinical improvement occurs 2, 3
- If initial amoxicillin fails, switch to amoxicillin-clavulanate at the doses above 2, 4
- Alternative: ceftriaxone 50 mg IM or IV for 3 days 2
- Beta-lactamase-producing organisms (particularly H. influenzae) are the predominant cause of treatment failure with amoxicillin monotherapy 4
Penicillin Allergy Alternatives
If true penicillin allergy exists, use: 2
- Cefdinir 14 mg/kg/day in 1 or 2 doses, OR
- Cefuroxime 30 mg/kg/day in 2 divided doses, OR
- Cefpodoxime 10 mg/kg/day in 2 divided doses
Important Clinical Caveats
- Always address pain management regardless of antibiotic choice 1, 3
- The high-dose regimen (80-90 mg/kg/day) is superior to standard-dose (40 mg/kg/day) for achieving adequate middle ear fluid concentrations, particularly against resistant S. pneumoniae 5, 4
- Approximately 87% of S. pneumoniae isolates are susceptible to high-dose amoxicillin compared to only 83% for standard-dose therapy 3
- Viral coinfection may reduce amoxicillin middle ear fluid penetration, further supporting the use of high-dose therapy 5