What is the recommended dosage and volume in milliliters (mL) for a 10-year-old male patient weighing 60 pounds with a right ear infection, specifically otitis media?

From the Guidelines

For a 10-year-old male weighing 60 pounds with a right ear infection, the recommended treatment is amoxicillin at a dose of 40 mg kg−1 BD for 5 days, as indicated by the World Health Organization pocket book of hospital care 1.

Calculation of Dosage

To calculate the dosage, we first need to convert the child's weight from pounds to kilograms. Since 1 pound is approximately equal to 0.45 kilograms, the child's weight in kilograms is 60 * 0.45 = 27 kilograms. Given the recommended dose of 40 mg kg−1 BD (twice daily) for 5 days for acute otitis media, the total daily dose would be 40 mg kg−1 * 27 kg = 1080 mg per day. Divided into two doses, this would be approximately 540 mg twice daily.

Administration

If using a common 250 mg/5 mL suspension, the volume of the dose can be calculated by dividing the dose by the concentration of the suspension. So, for 540 mg, it would be 540 mg / 250 mg per 5 mL = 10.8 mL, or approximately 11 mL twice daily for 5 days.

Importance of Treatment

It's crucial to complete the full course of antibiotics as prescribed to ensure the infection is fully cleared and to prevent potential complications such as mastoiditis or hearing loss. The child should be monitored for improvement in symptoms and re-evaluated if there's no significant improvement within 48-72 hours, as this could indicate antibiotic resistance or a different diagnosis. Pain management with acetaminophen or ibuprofen can also be considered to alleviate discomfort, with dosages adjusted according to the child's weight and clinical guidelines.

From the FDA Drug Label

Acute Otitis Media The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute otitis media is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5.

PEDIATRIC DOSAGE GUIDELINES FOR OTITIS MEDIA, ACUTE BACTERIAL SINUSITIS AND COMMUNITY-ACQUIRED PNEUMONIA (Age 6 months and above, see PRECAUTIONS—Pediatric Use.) Based on Body Weight OTITIS MEDIA AND COMMUNITY-ACQUIRED PNEUMONIA: (5-Day Regimen)

• Dosing Calculated on 10 mg/kg/day Day 1 and 5 mg/kg/day Days 2 to 5. Weight100 mg/5 mL200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs. Day 1Days 2–5Day 1Days 2–5 *Effectiveness of the 3-day or 1-day regimen in pediatric patients with community-acquired pneumonia has not been established. 5112.5 mL (½ tsp) 1.25 mL (¼ tsp) 7.5 mL150 mg 10225 mL (1 tsp) 2.5 mL (½ tsp) 15 mL300 mg 20445 mL (1 tsp) 2.5 mL (½ tsp) 15 mL600 mg 30667.5 mL (1½ tsp) 3.75 mL (¾ tsp) 22. 5 mL900 mg 408810 mL (2 tsp) 5 mL (1 tsp) 30 mL1200 mg 50 and above110 and above12.5 mL (2½ tsp) 6.25 mL (1¼ tsp) 37.5 mL1500 mg OTITIS MEDIA AND ACUTE BACTERIAL SINUSITIS: (3-Day Regimen)
• Dosing Calculated on 10 mg/kg/day Weight100 mg/5 mL200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs. Day 1–3Day 1–3 *Effectiveness of the 5-day or 1-day regimen in pediatric patients with acute bacterial sinusitis has not been established. 5112.5 mL (1/2 tsp) 7.5 mL150 mg 10225 mL (1 tsp) 15 mL300 mg 20445 mL (1 tsp) 15 mL600 mg 30667.5 mL (1 ½ tsp) 22.5 mL900 mg 408810 mL (2 tsp) 30 mL1200 mg 50 and above110 and above12.5 mL (2 ½ tsp) 37. 5 mL1500 mg OTITIS MEDIA: (1-Day Regimen) Dosing Calculated on 30 mg/kg as a single dose Weight200 mg/5 mLTotal mL per Treatment CourseTotal mg per Treatment Course KgLbs.Day 1 5113.75 mL (3/4 tsp) 3.75 mL150 mg 10227.5 mL (1 ½ tsp) 7.5 mL300 mg 204415 mL (3 tsp) 15 mL600 mg 306622.5 mL (4 ½ tsp) 22.5 mL900 mg 408830 mL (6 tsp) 30 mL1200 mg 50 and above110 and above37.5 mL (7 ½ tsp) 37. 5 mL1500 mg

For a 10-year-old male weighing 60 pounds (approximately 27 kg), the recommended dose for acute otitis media is:

• 30 mg/kg as a single dose: 30 mg/kg x 27 kg = 810 mg, which corresponds to 30 mL (6 tsp) of the 200 mg/5 mL suspension, or
• 10 mg/kg once daily for 3 days: 10 mg/kg x 27 kg = 270 mg per day, which corresponds to 13.5 mL (2 ¾ tsp) of the 200 mg/5 mL suspension per day, or
• 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5: 10 mg/kg x 27 kg = 270 mg on the first day, which corresponds to 13.5 mL (2 ¾ tsp) of the 200 mg/5 mL suspension, and 5 mg/kg x 27 kg = 135 mg per day on Days 2-5, which corresponds to 6.75 mL (1 ⅜ tsp) of the 200 mg/5 mL suspension per day. 2

From the Research

Dosage Information for a 10-year-old Male Weighing 60 Pounds with a Right Ear Infection

• The dosage of amoxicillin for a child with acute otitis media is 20 mg/kg (maximum, 750 mg) twice daily for 7 to 10 days 3.
• For a 60-pound (approximately 27.2 kg) child, the dosage would be approximately 544 mg (27.2 kg x 20 mg/kg) twice daily.
• The dosage of clarithromycin for a child with acute otitis media is 7.5 mg/kg (maximum, 500 mg) twice daily 3.
• For a 60-pound (approximately 27.2 kg) child, the dosage would be approximately 204 mg (27.2 kg x 7.5 mg/kg) twice daily.
• To convert milligrams (mg) to milliliters (mL), the concentration of the suspension must be known, as it can vary between products.

Concentration of Suspensions

• Typical concentrations for amoxicillin suspensions are 200 mg/5 mL or 400 mg/5 mL.
• Typical concentrations for clarithromycin suspensions are 125 mg/5 mL or 250 mg/5 mL.
• Using the calculated dosage and concentration, the volume of suspension can be determined. For example, if the amoxicillin suspension is 200 mg/5 mL, the volume for a 544 mg dose would be approximately 13.6 mL (544 mg / 40 mg/mL).

Treatment Options

• Amoxicillin-clavulanate is recommended as the treatment of choice for children between 6 months and 12 years of age with acute otitis media 4.
• Azithromycin, clarithromycin, and other antibiotics may be considered as alternatives, but their effectiveness and potential side effects should be evaluated on a case-by-case basis 3, 4, 5, 6.