What is the recommended dose of amoxicillin (amoxicillin) for a 1-year-old patient with otitis media?

Amoxicillin Dosing for Otitis Media in a 1-Year-Old

For a 1-year-old child with acute otitis media, prescribe high-dose amoxicillin at 80-90 mg/kg/day divided into 2 doses for 10 days. 1, 2

Dose Calculation

• Calculate the total daily dose by multiplying the child's weight in kilograms by 80-90 mg 1, 2

  • For example, a 10 kg child would receive 800-900 mg total per day
  • Divide this into 2 equal doses given approximately 12 hours apart 1, 2

• High-dose amoxicillin (80-90 mg/kg/day) is the first-line treatment because it provides effective coverage against drug-resistant Streptococcus pneumoniae while maintaining safety, low cost, acceptable taste, and narrow microbiologic spectrum 1, 2, 3

Treatment Duration

• Treat for 10 days in children younger than 2 years with acute otitis media 1
• Children under 2 years, particularly those with bilateral disease, benefit most from antibiotic therapy with a number needed to treat of approximately 3 1

When to Use Amoxicillin-Clavulanate Instead

Switch to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day clavulanate in 2 divided doses) if: 1, 2

• The child received amoxicillin in the previous 30 days
• Concurrent purulent conjunctivitis is present
• Coverage for β-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis is desired

Reassessment and Treatment Failure

• Reassess at 48-72 hours if symptoms fail to improve 1, 2
• Treatment failure is defined as worsening condition, persistence of symptoms beyond 48 hours, or no improvement by day 4-5 1, 2
• If treatment fails, switch to amoxicillin-clavulanate or ceftriaxone (50 mg IM or IV for 3 days) 1, 2
• β-lactamase-producing H. influenzae is the most common cause of amoxicillin treatment failure, occurring in approximately 62% of bacteriologic failures 4

Pain Management

• Address pain management concurrently with antibiotic therapy during the first 24 hours using appropriate analgesics 2

Important Clinical Context

• In children 6-24 months with acute otitis media, antibiotics provide modest benefit with a number needed to treat of 7-8 to improve symptomatic outcome at day 4 1, 5
• However, children younger than 2 years with bilateral AOM or otorrhea derive the greatest benefit from antibiotic treatment 1
• The clinical failure rate at day 10-12 is significantly lower with amoxicillin-clavulanate (16%) compared to placebo (51%) in children under 2 years with stringent diagnostic criteria 1