Acute otitis media

500 mg TID x 5-7 days

40-90 mg/kg/day [child max 1000 mg]

(Divided BID-TID; high dose (80-90) where pneumococcal resistance is likely ENDF caps amoxicillin at 500 mg per dose for most indications; at the twice-daily schedule this regimen uses, that is 1,000 mg in a day, which is the ceiling applied to the table above (ENDF Antimicrobial 2023).)

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph)

High-dose amoxicillin (80-90 mg/kg/day) where pneumococcal resistance is likely.

875 mg twice daily or 500 mg every 8 hours x 5-7 days

80-90 mg/kg/day [child max 4000 mg]

(Of the amoxicillin component, divided BID. Use a 14:1 ES formulation (AUGMENTIN ES-600 or a 642.9 mg/5 mL suspension) so clavulanate stays under 10 mg/kg/day at this dose.)

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)

High-dose 80-90 mg/kg/day is standard for AOM where pneumococcal resistance is likely. It requires a 14:1 ES product, which is sold in Egypt; a 7:1 product at this dose would deliver toxic clavulanate.

Total daily dose 600 mg - as 300 mg twice daily or 600 mg once daily x 10 days

14 mg/kg/day [child max 600 mg]

(14 mg/kg/day in 1 or 2 divided doses, maximum 600 mg/day, for 10 days. Suspension 125 mg/5 mL and 250 mg/5 mL. If creatinine clearance is below 30 mL/min/1.73 m2, give 7 mg/kg once daily to a maximum of 300 mg/day.)

Egyptian National Drug Formulary - Antimicrobial 2023 (cefdinir monograph)

32 live products, mostly paediatric suspension, and the formulary lists acute bacterial otitis media in children as a named indication. Once-daily dosing and better palatability than amoxicillin-clavulanate make it the practical option when a child will not take the first-line suspension.

No adult dose for acute otitis media appears in any source cited for it. The Egyptian formulary lists acute otitis media as an azithromycin indication but doses it in adults only for COPD exacerbation, pneumonia, sexually transmitted infection and strep pharyngitis; the disease article gives only the paediatric 10 mg/kg single dose. For a penicillin-allergic adult, cefdinir carries a sourced adult dose.

Oral: 10 to 12 mg/kg/dose once on day 1 (usual maximum dose: 500 mg/dose) followed by 5 to 6 mg/kg once daily (usual maximum dose: 250 mg/dose) for remainder of treatment duration.

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph)

Macrolide antibiotic reserved for patients with penicillin allergy; rising resistance among the usual otitis media pathogens is why it sits behind, rather than alongside, the penicillin-based options.

1 to 2 g once daily by intramuscular or intravenous injection x 3 days

50 mg/kg/day [child max 1000 mg]

(50 mg/kg once a day for 3 days, IM or IV. The formulary caps a mild-to-moderate daily dose at 1,000 mg.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - verbatim: "General Adult Dosage IV or IM 1-2 g once or devided twice daily."

Vomiting is the common reason an ear infection goes untreated in a small child. A three-day intramuscular course, given in the clinic, is the article's named alternative, and the formulary lists acute otitis media among ceftriaxone's indications.

1 g three or four times daily, maximum 4 g in 24 hours

15 mg/kg/dose [child max 500 mg]

(15 mg/kg per dose three or four times daily from 1 month of age, maximum 60 mg/kg/day. Under 1 month, 10 mg/kg per dose three or four times daily, maximum 40 mg/kg/day.)

MSF Essential Drugs 2024 - paracetamol (oral)

The ear pain is what brought the child in, and it needs treating whether or not an antibiotic is written - AAFP's otitis media review says management should begin with adequate analgesia and that analgesics are recommended for ear pain, fever and irritability. The dose here is the drug reference's, not the guideline's.

200-400 mg up to three times daily with or after food, maximum 1200 mg in 24 hours

20 mg/kg/day

(20 mg/kg/day in divided doses for pain and fever. Label bands: 3-6 months (over 5 kg) 50 mg three times daily; 6-12 months 50 mg three to four times daily; 1-4 years 100 mg three times daily; 4-7 years 150 mg three times daily; 7-12 years 200 mg three times daily. Not under 3 months. From 12 years use the adult dose.)

Sourced preference. The entry's own citation - AAFP's otitis media review - prefers ibuprofen to paracetamol here, for longer duration of action and the anti-inflammatory effect on the drum.

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)

AAFP's otitis media review prefers ibuprofen to paracetamol here, for its longer duration of action and lower toxicity in overdose. The dose is the drug label's.