Antibiotic dosing for acute otitis media in children: a weighty issue

Pediatr Emerg Care. 2010 Jan;26(1):19-25. doi: 10.1097/PEC.0b013e3181cbeb00.


Background: The American Academy of Pediatrics 2004 guidelines on diagnosis and management of acute otitis media (OM) recommends use of high-dose amoxicillin for the treatment of acute uncomplicated OM. With rising childhood obesity, recommended amoxicillin dose of 80 to 90 mg/kg per day often exceed standard adult dose of 1500 mg/d.

Objective: To study prescribing patterns of primary care physicians for amoxicillin in the treatment of OM. To assess opinions of American Academy of Pediatrics subcommittee members who participated in guideline formulation.

Methods: This study had 2 parts. Part 1: Retrospective review of medical records of children visiting the hospital between April and June 2008 and with a diagnosis of OM and were prescribed amoxicillin. Part 2: Web-based survey of 14 members of the OM guidelines subcommittee.

Results: Part 1: Three hundred fifty-nine children were eligible, with a mean (SD) age of 3.2 (4.0) years and 185 (51.5%) of whom were males. Children weighing 20 kg or less received higher mean daily dose of amoxicillin (74.2 vs 40.4 mg/kg per day, P < 0.00). Part 2: Nine (64.3%) subcommittee members responded to the survey. Most (77.8%) affirmed that the impact of obesity on high-dose amoxicillin recommendation was not discussed during guideline formulation. If a patient's estimated amoxicillin dose exceeded the standard adult dose (1500 mg/d), 66.7% members would prescribe the standard adult dose whereas 33.3% would prescribe the recommended dose of 80 to 90 mg/kg per day.

Conclusions: Primary care physicians prescribe a significantly lower-than-recommended amoxicillin dose in older children and those in the higher weight category. The opinion among subcommittee members regarding maximum dose specification of amoxicillin is varied.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Acute Disease
  • Amoxicillin / administration & dosage*
  • Anti-Bacterial Agents / administration & dosage*
  • Body Weight*
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Drug Prescriptions / standards*
  • Female
  • Follow-Up Studies
  • Guideline Adherence
  • Humans
  • Male
  • Otitis Media / drug therapy*
  • Prescription Drugs
  • Retrospective Studies
  • Surveys and Questionnaires


  • Anti-Bacterial Agents
  • Prescription Drugs
  • Amoxicillin