From the Guidelines
For a 7-year-old child weighing 97 pounds (approximately 44 kg) with acute otitis media (AOM), the maximum recommended dose of amoxicillin is 90 mg/kg/day, which equals approximately 3960 mg per day. According to the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guideline on diagnosis and management of acute otitis media 1, when amoxicillin is used, the dosage should be 80 to 90 mg per kg per day. This option is based on extrapolation from microbiologic studies and expert opinion, with preponderance of benefit over risk. Key points to consider when prescribing amoxicillin for 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
- 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
- The optimal duration of therapy for patients with AOM is uncertain, but typical treatment duration is 10 days. It's essential to note that if the child has a penicillin allergy, alternative antibiotics would be recommended instead, such as cefdinir or cefpodoxime, as suggested by the guideline 1.
From the Research
Amoxicillin Dosage for Acute Otitis Media (AOM)
- The maximum amoxicillin dose for a 7-year-old child with AOM, weighing 97 lbs, can be determined based on the recommended dosage per kilogram of body weight.
- According to the study 2, amoxicillin at conventional or high doses (80-90 mg/kg/day) remains an appropriate choice for first-line therapy for AOM.
- To calculate the maximum dose, we need to convert the child's weight from pounds to kilograms: 97 lbs / 2.2 lbs/kg = approximately 44 kg.
- Using the high-dose recommendation of 90 mg/kg/day, the maximum dose would be: 44 kg x 90 mg/kg/day = 3960 mg/day.
- This dose can be divided into two or three doses per day, depending on the specific prescription and treatment plan.
Considerations for Amoxicillin Dosage
- The study 3 compared clarithromycin and amoxicillin suspensions in the treatment of pediatric patients with AOM, but did not provide specific dosage recommendations for amoxicillin.
- The study 4 compared clarithromycin and amoxicillin-clavulanate in the treatment of AOM, and used a dose of 15 mg/kg twice daily for clarithromycin, but did not provide specific dosage recommendations for amoxicillin.
- The study 5 compared the efficacy of antimicrobials or placebo with amoxicillin-clavulanate in children with AOM, and found that amoxicillin-clavulanate was superior to some antimicrobials, but did not provide specific dosage recommendations for amoxicillin.
- The study 6 compared immediate orally administered, immediate topically administered, or delayed orally administered antibiotics for AOM with discharge in children, and used a dose of amoxicillin (clarithromycin if penicillin allergic), but did not provide specific dosage recommendations for amoxicillin.