Amoxicillin Dosing for 17-Month-Old with Acute Otitis Media
Give high-dose amoxicillin at 80-90 mg/kg/day divided into two doses (every 12 hours) for a full 10-day course. 1, 2
Dose Calculation
- Calculate the total daily dose by multiplying your child's weight in kilograms by 80-90 mg, then divide this amount in half to give every 12 hours. 2
- For example, if your 17-month-old weighs 11 kg (approximately 24 pounds), the total daily dose would be 880-990 mg/day, giving 440-495 mg twice daily. 2
- Twice-daily dosing is equally effective as three-times-daily administration and significantly improves adherence, making it the preferred regimen. 2, 3, 4
Why High-Dose Therapy is Critical at This Age
- Children under 2 years require high-dose amoxicillin because they have higher treatment failure rates with standard dosing (40-45 mg/kg/day), and high-dose therapy achieves adequate middle ear fluid concentrations against drug-resistant Streptococcus pneumoniae. 1, 2
- High-dose amoxicillin provides 87% susceptibility against resistant pneumococcal strains compared to 83% with standard dosing, and reduces treatment failure from 23% to approximately 4% by days 4-5. 2
- The number needed to treat is only 3 for children younger than 2 years with bilateral AOM, making antibiotics highly effective in this age group. 2
Treatment Duration
- Always prescribe a full 10-day course for children under 2 years, regardless of symptom severity or improvement. 1, 2
- Do not use shortened 5-7 day courses in this age group, as children younger than 24 months require the full 10-day duration based on moderate-to-high quality evidence. 2
When to Switch Antibiotics
- Reassess at 48-72 hours if symptoms fail to improve or worsen. 1, 2
- If treatment fails, escalate to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day clavulanate in 2 divided doses), which provides coverage against β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis. 1, 2
- Also start with amoxicillin-clavulanate instead of plain amoxicillin if your child received amoxicillin in the previous 30 days or has concurrent purulent conjunctivitis. 1, 2
Pain Management
- Address pain control with analgesics (acetaminophen or ibuprofen) during the first 24-48 hours, regardless of antibiotic choice, as pain relief is a critical component of AOM management. 2
Common Pitfalls to Avoid
- Never use standard-dose amoxicillin (40-45 mg/kg/day) in children under 2 years, as it provides inadequate coverage for resistant organisms and has unacceptably high failure rates. 2
- Do not use macrolides (azithromycin, clarithromycin) as first-line therapy, as they have only 20-25% effectiveness against major AOM pathogens and are inferior to high-dose amoxicillin. 1, 2
- Do not prescribe additional antibiotics for persistent middle ear effusion without acute symptoms, as 60-70% of children have residual fluid at 2 weeks, which is normal and does not require treatment. 2