Antibiotic dosing for acute otitis media in children: a weighty issue.
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.
Christian-Kopp
Sarah
S
Department of Emergency Medicine, Arizona Children's Center at Maricopa Medical Center, Maricopa Integrated Health Systems, Phoenix, AZ 85008, USA.
Sinha
Madhumita
M
Rosenberg
David I
DI
Eisenhart
Anita W
AW
McDonald
Fred W
FW
D000208:Acute Disease; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001835:Body Weight; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000188:drug therapy*; D055553:Prescription Drugs; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents; D055553:Prescription Drugs; D000658:Amoxicillin