From the Guidelines
For a 7-year-old child with otitis media, the recommended dose of amoxicillin-clavulanate is 90 mg/kg/day of the amoxicillin component, with 6.4 mg/kg/day of clavulanate, divided into two doses. This dosage is based on the most recent and highest quality study available, which recommends high-dose amoxicillin-clavulanate as the first-line treatment for otitis media in children who have taken amoxicillin in the previous 30 days, those with concurrent conjunctivitis, or those for whom coverage for Moraxella catarrhalis is desired 1.
Key Considerations
- The amoxicillin-clavulanate ratio is 14:1, which is crucial for effective treatment against common otitis media pathogens, including beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis, as well as resistant pneumococci.
- The medication should be given with food to reduce gastrointestinal side effects.
- Parents should complete the full course of treatment, even if symptoms improve earlier, to ensure complete eradication of the infection.
Dosage Calculation
- For a 7-year-old child weighing approximately 20-25 kg, the dose would be 45 mg/kg given twice daily, which translates to about 900-1125 mg of amoxicillin component twice daily.
- The high-dose formulation (Augmentin ES-600) containing 600 mg amoxicillin/42.9 mg clavulanate per 5 mL is often preferred for otitis media due to concerns about resistant Streptococcus pneumoniae.
Alternative Treatments
- If the child has a penicillin allergy, alternative antibiotics like cefdinir or azithromycin may be considered, as the risk of cross-reactivity between penicillins and cephalosporins is lower than historically reported 1.
From the Research
Amoxicillin-Clavulanate Dosage for Otitis Media in Children
- The dosage of amoxicillin-clavulanate for the treatment of otitis media in children is not explicitly stated in the provided studies.
- However, according to the study 2, amoxicillin-clavulanate is recommended as the treatment of choice for children between 6 months and 12 years of age with acute otitis media.
- The study 3 mentions that amoxicillin suspension was given in a dose of 20 mg/kg (maximum, 750 mg) twice daily for 7 to 10 days, but this study was comparing clarithromycin and amoxicillin suspensions, not amoxicillin-clavulanate.
- The study 4 compares the efficacy and safety of azithromycin and amoxicillin/clavulanate for the treatment of otitis media in children, but does not provide a specific dosage for amoxicillin-clavulanate.
- The study 5 evaluates the efficacy of clarithromycin treatment of acute otitis media, but does not provide information on amoxicillin-clavulanate dosage.
Considerations for Treatment
- The choice of antibiotic and dosage may depend on various factors, including the severity of the infection, the age and weight of the child, and the presence of any underlying medical conditions.
- The study 6 highlights the importance of considering the causative pathogens and antibiotic resistance when selecting antibiotics for treatment of acute otitis media.
- The study 2 suggests that amoxicillin-clavulanate is effective in eradicating Streptococcus pneumoniae from the culture, but the rates of AOM relapse after treatment with amoxicillin-clavulanate were comparable to those of other antimicrobials or placebo.