From the Guidelines
For a 13-year-old with mild to moderate acute otitis media, the recommended dosage of amoxicillin is 90 mg/kg/day divided into two doses, with a maximum of 4000 mg/day, as indicated by the most recent and highest quality study 1. The dosage should be divided into two doses, with a maximum of 2000 mg per dose. For most 13-year-olds, this would mean 875-1000 mg twice daily for 5-7 days.
- The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend amoxicillin as the first-line treatment for acute otitis media (AOM) because it provides good coverage against Streptococcus pneumoniae, the most common bacterial cause of otitis media 1.
- The medication should be taken with food to minimize gastrointestinal side effects.
- If symptoms don't improve within 48-72 hours or worsen at any time, the patient should be reevaluated as they may need a different antibiotic, such as amoxicillin-clavulanate, if beta-lactamase producing organisms are suspected.
- Adequate pain management with acetaminophen or ibuprofen should also be provided as needed. Key considerations for the treatment of AOM include:
- The patient's weight and age to determine the appropriate dosage of amoxicillin
- The presence of risk factors for resistant organisms, such as recent antibiotic use, treatment failure, or daycare attendance
- The potential for gastrointestinal side effects and the need for adequate pain management. The most recent study 1 provides the highest quality evidence for the recommended dosage of amoxicillin in children with AOM.
From the FDA Drug Label
Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a 45 mg/kg/day every 12 hours Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections Patients Weighing 40 kg or More: Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations
For a 13-year-old patient with mild/moderate acute otitis media, the max dosing of amoxicillin is 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours for patients under 40 kg, and according to adult recommendations for patients weighing 40 kg or more 2.
From the Research
Amoxicillin Dosing for Acute Otitis Media
- The maximum dosing of amoxicillin for a 13-year-old with mild/moderate acute otitis media is not explicitly stated in the provided studies, as the age range of the studies is generally limited to children between 6 months and 12 years of age.
- However, according to the study 3, amoxicillin at conventional or high doses (80-90 mg/kg/day) remains an appropriate choice for first-line therapy for AOM.
- The study 3 also mentions that for patients in whom amoxicillin is unsuccessful, second-line therapy should have demonstrated activity against penicillin-resistant S. pneumoniae as well as beta-lactamase-producing pathogens, and high-dose amoxicillin/clavulanate (90 mg/kg/day based on the amoxicillin component) is an appropriate option.
- It is essential to note that the dosing recommendations may vary depending on the specific circumstances of the patient and the severity of the infection.
Comparison of Amoxicillin with Other Antimicrobials
- The study 4 compared the efficacy of amoxicillin-clavulanate with other antimicrobials, including azithromycin, cefdinir, and placebo, and found that amoxicillin-clavulanate was superior to some of these alternatives in eradicating Streptococcus pneumoniae from the culture.
- The study 5 compared the bacteriologic and clinical efficacy of amoxicillin/clavulanate and azithromycin in patients with AOM and found that amoxicillin/clavulanate was significantly more likely to eradicate all bacterial pathogens and Haemophilus influenzae from middle ear fluid than azithromycin.
- The study 6 compared the efficacy and safety of azithromycin and amoxicillin/clavulanate in pediatric acute otitis media and found that both treatments had similar efficacy, but azithromycin was significantly better tolerated.