Related Experiment Video

Updated: Jun 17, 2026

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity
09:52

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity

Published on: March 16, 2018

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

Sarah Christian-Kopp1, Madhumita Sinha, David I Rosenberg

  • 1Department of Emergency Medicine, Arizona Children's Center at Maricopa Medical Center, Maricopa Integrated Health Systems, Phoenix, AZ 85008, USA.

Pediatric Emergency Care
|January 1, 2010
PubMed

Insights

Pediatricians often underdose amoxicillin for children with otitis media, especially those who are older or heavier. Experts had varied opinions on maximum amoxicillin dosing, indicating a need for clearer guidelines.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Pharmacology

Background:

  • The American Academy of Pediatrics (AAP) 2004 guidelines recommend high-dose amoxicillin (80-90 mg/kg/day) for acute otitis media (OM).
  • Rising childhood obesity rates mean recommended doses can exceed standard adult limits (1500 mg/day).

Purpose of the Study:

  • To investigate primary care physician prescribing patterns for amoxicillin in treating OM.
  • To gauge the perspectives of AAP subcommittee members involved in OM guideline development.

Main Methods:

  • A two-part study: Part 1 involved a retrospective review of medical records for children diagnosed with OM and prescribed amoxicillin.
  • Part 2 consisted of a web-based survey distributed to 14 members of the OM guidelines subcommittee.

Main Results:

  • Children weighing 20 kg or less received significantly higher mean amoxicillin doses (74.2 mg/kg/day) compared to heavier children (40.4 mg/kg/day).
  • Most subcommittee members (77.8%) indicated obesity's impact on high-dose amoxicillin recommendations was not discussed during guideline formulation.
  • If a calculated dose exceeded 1500 mg/day, 66.7% of surveyed members would prescribe the adult dose, while 33.3% would adhere to the pediatric recommendation.

Conclusions:

  • Primary care physicians tend to prescribe lower amoxicillin doses than recommended for older children and those in higher weight categories.
  • There is a lack of consensus among guideline subcommittee members regarding the specification of a maximum amoxicillin dose.
Abstract

Related Concept Videos

Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
Tonsillitis II: Management01:26

Tonsillitis II: Management

This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...