Otitis Media Child Doses

Consider a no or delayed antibiotic strategy A+

Note Doses are oral unless otherwise stated. Visit the Health Products Regulatory Authority website for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide. Letters indicating strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

Click here to view The National Clinical Programme for Paediatrics and Neonatology Clinical Care algorithm for Otits media in children

Comments from Expert Advisory Committee

  1. Many are viral. Illness resolves over 4 days in 80% without antibiotics. A+
  2. Antibiotics do not reduce pain in first 24 hours, subsequent attacks or deafness. A+
  3. Need to treat 20 children >2y and seven 6-24m old to get pain relief in one at 2-7 days. A+ B+
  4. Children with otorrhoea, or <2years with bilateral acute otitis media, have greater benefit but are still eligible for delayed prescribing. A+
  5. Haemophilus is an extracellular pathogen, thus macrolides, which concentrate intracellularly, are less effective treatment.
  6. Antibiotics to prevent mastoiditis NNT>4000. B

Symptomatic relief

Use NSAID or paracetamol. A-


Consider a no or delayed antibiotic strategy. A+

If antibiotics deemed clinically indicated:

Amoxicillin preferred antibiotic. Recommended duration 5 days

See guidance on Amoxicillin dosing in children

Age  Normal Dose Maximum Dose Maximum dose check (average weight for age)
1-11 months 125mg TDS 30mg/kg per dose to be given 3 times daily 1 month (4.3kg): 125mg 3 times daily
11 months (8kg): 250mg 3 times daily
1-4 years 250mg TDS 30mg/kg per dose to be given 3 times daily 1 yr (9kg): 250mg 3 times daily
4 yrs (16kg): 500mg 3 times daily
5-11 years 500mg TDS 30mg/kg per dose to be given 3 times daily 5 yrs (18kg) : 500mg 3 times daily
11 yrs (35kg): 1g 3 times daily
12-17 years 500mg TDS 1g 3 times daily 1g 3 times daily

Please note: various strengths of Amoxicillin powder for suspension available:

  • 125mg/ 1.25ml
  • 125mg/5ml
  • 250mg /5ml

Clarithromycin if penicillin allergic. Recommended duration 5 days

See guidance on Clarithromycin dosing in children

Approximate Age   Weight Dose
(based on 7.5mg/kg per dose twice daily)
1-2 years 8-11kg 62.5mg per dose to be given twice daily
3-6 years 12-19kg 125mg per dose to be given twice daily
7-9 years 20-29kg 187.5mg per dose to be given twice daily
10-12 years 30-40kg 250mg per dose to be given twice daily

Preparations available for children: Clarithromycin Granules for Oral Solution: 125mg/5mls and 250mg/5mls, 250mg tablets. Prolonged release tablets not recommended in children.

Patient Information

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Reviewed - Nov 2018

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