Amoxicillin Dosing for Acute Otitis Media Using 400 mg/5 mL Suspension
For a 2-year-old child weighing 14.8 kg with acute otitis media, administer 6.7 mL of the 400 mg/5 mL suspension twice daily (providing approximately 90 mg/kg/day) for 10 days. 1, 2, 3
Rationale for High-Dose Regimen
High-dose amoxicillin (80-90 mg/kg/day) is the recommended first-line therapy for acute otitis media in children under 2 years of age, as this dosing achieves adequate middle ear fluid concentrations to overcome penicillin-resistant Streptococcus pneumoniae and provides optimal coverage against Haemophilus influenzae and Moraxella catarrhalis. 1, 3
The American Academy of Pediatrics specifically recommends 90 mg/kg/day divided into 2 doses for children with acute otitis media, particularly those under 2 years old, as this age group has higher rates of treatment failure with standard dosing. 1, 3
For this 14.8 kg child, the calculation is: 14.8 kg × 90 mg/kg/day = 1,332 mg/day total, divided into 2 doses = 666 mg per dose, which equals approximately 6.7 mL of 400 mg/5 mL suspension twice daily. 1
Treatment Duration and Monitoring
Complete a full 10-day course of therapy for acute otitis media, as this duration is necessary to prevent treatment failure and reduce the risk of recurrent infection. 1, 2, 3, 4
Clinical improvement should be evident within 48-72 hours of starting therapy; if no improvement or worsening occurs, reevaluation is necessary and consideration should be given to switching to amoxicillin-clavulanate or ceftriaxone. 1, 3
Pain management with acetaminophen or ibuprofen should be provided systematically during the first 24-48 hours regardless of antibiotic choice. 3
When to Consider Alternative Therapy
Switch to amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) if the child received amoxicillin within the past 30 days, has concurrent purulent conjunctivitis, or shows no improvement after 48-72 hours of high-dose amoxicillin. 2, 3
For treatment failure after 48-72 hours, ceftriaxone (50 mg/kg IM as a single dose or daily for 3 days) is the recommended second-line option. 3
Administration Instructions
Administer the suspension at the start of a meal to minimize gastrointestinal intolerance. 4
Shake the oral suspension well before each use, and ensure the bottle is kept tightly closed. 4
The reconstituted suspension remains stable for 14 days; refrigeration is preferable but not required. 4
Common Pitfalls to Avoid
Do not use standard-dose amoxicillin (40-45 mg/kg/day) for children under 2 years with acute otitis media, as this dosing is inadequate to eradicate resistant S. pneumoniae and is associated with higher treatment failure rates. 1, 5, 6
Avoid prescribing antibiotics without proper visualization of the tympanic membrane showing bulging, limited mobility, or effusion, as isolated redness does not indicate acute otitis media. 3
Do not discontinue therapy early even if symptoms improve before completion of the 10-day course, as premature discontinuation increases the risk of recurrence and promotes antibiotic resistance. 1, 4