Amoxicillin Dosing for AOM in a 16-Year-Old Male (53 kg)
For this 16-year-old male weighing 53 kg with acute otitis media, prescribe amoxicillin 875 mg twice daily (or 500 mg three times daily) for 5-7 days, which provides approximately 33 mg/kg/day—adequate for adolescents with standard AOM. 1, 2, 3
Dosing Rationale for Adolescents vs. Children
Adolescents and adults do not require the high-dose pediatric regimen (80-90 mg/kg/day) that is recommended for young children to overcome resistant Streptococcus pneumoniae. 1, 2
The standard adult dosing of 875 mg twice daily or 500 mg three times daily is appropriate for patients weighing >40 kg, which includes this 53 kg adolescent. 3
The FDA label specifically states that for patients ≥40 kg with ear/nose/throat infections of mild-to-moderate severity, the recommended dose is 500 mg every 12 hours or 250 mg every 8 hours, and for severe infections 875 mg every 12 hours or 500 mg every 8 hours. 3
Treatment Duration
For children ≥6 years with mild-to-moderate AOM, a 5-7 day course is recommended by the American Academy of Pediatrics, which applies to this 16-year-old. 1, 2
A 10-day course is reserved for children under 2 years or those with severe symptoms. 1
When to Use High-Dose or Alternative Therapy
Switch to amoxicillin-clavulanate (875/125 mg twice daily for adults/adolescents) if: 1, 2
- The patient received amoxicillin in the previous 30 days
- Concurrent purulent conjunctivitis is present
- No improvement after 48-72 hours of standard amoxicillin
High-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) is primarily indicated for young children (<2 years, daycare attendees) at high risk for resistant pathogens, not typically for adolescents. 1, 2
Pain Management
Address pain immediately with acetaminophen or ibuprofen, regardless of antibiotic choice, especially during the first 24 hours. 1
Pain relief often occurs before antibiotics provide benefit, as antibiotics do not provide symptomatic relief in the first 24 hours. 1
Reassessment Criteria
Reassess at 48-72 hours if symptoms fail to improve or worsen. 1, 2
Treatment failure warrants switching to amoxicillin-clavulanate or considering ceftriaxone (50 mg/kg IM/IV daily for 1-3 days). 1
Common Pitfall to Avoid
Do not automatically use high-dose pediatric regimens (80-90 mg/kg/day) for adolescents—this dosing is specifically designed for young children with higher risk of resistant S. pneumoniae and would result in excessive dosing (4,240-4,770 mg/day) for this patient. 1, 2
The research showing high-dose amoxicillin efficacy was conducted in children with median age 9 months, not adolescents. 4, 5