From the Guidelines
For a 10-year-old child weighing 30 kg with acute otitis media, the recommended dose of amoxicillin is 80 to 90 mg per kg per day, which translates to approximately 2400 to 2700 mg per day. This dose is based on the guideline released by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) 1. The dosage is recommended to be divided into two or three doses per day.
Key Considerations
- The choice of amoxicillin as first-line therapy is due to its effectiveness against susceptible and intermediate resistant pneumococci, as well as its safety, affordability, and acceptable taste 1.
- The optimal duration of therapy for patients with acute otitis media is uncertain, but a common duration is 5-7 days.
- It is essential to consider the potential for penicillin allergy and have alternative treatments available, such as cefdinir, cefpodoxime, or cefuroxime, if the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction 1.
Additional Recommendations
- Pain management with acetaminophen or ibuprofen is crucial for symptom relief.
- The child should show improvement within 48-72 hours; if symptoms worsen or don't improve, reevaluation is necessary to consider alternative antibiotics.
- High-dose amoxicillin is preferred due to the increasing prevalence of drug-resistant Streptococcus pneumoniae.
From the Research
Dosage Information for Acute Otitis Media
- For a 10-year-old child weighing 30 kg with acute otitis media, the dosage of amoxicillin can be determined based on the recommended dose of 80 to 90 mg/kg per day 2.
- This would translate to a total daily dose of 2400 to 2700 mg of amoxicillin, which is higher than the standard adult dose of 1500 mg/d 2.
- However, some studies suggest that primary care physicians often prescribe lower-than-recommended doses of amoxicillin for older children and those in higher weight categories 2.
- The American Academy of Pediatrics recommends using high-dose amoxicillin for the treatment of acute uncomplicated otitis media, but the impact of obesity on this recommendation was not discussed during guideline formulation 2.
- Alternative antibiotics such as clarithromycin have been studied for the treatment of acute otitis media in children, with dosages ranging from 7.5 mg/kg twice daily to 15 mg/kg twice daily 3, 4, 5.
- The choice of antibiotic and dosage should be determined based on the specific needs of the patient and the severity of the infection, as well as consideration of potential side effects and interactions 3, 4, 5, 6.