Special dosage of amoxicillin for acute otitis media, gonorrhea, lyme disease, H.pylori

Special dosage of amoxicillin for acute otitis media, gonorrhea, lyme disease, H.pylori
Acute Otitis Media
For the treatment of uncomplicated acute otitis media (AOM), the recommended dosage of amoxicillin is 80-90 mg/kg daily given in 2 or 3 divided doses. The drug usually is given for 10 days, but the optimal duration of therapy is uncertain.2550 The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) recommend that a 10-day regimen be used for treatment of AOM in children younger than 6 years of age and in those with severe disease, but that a duration of 5-7 days may be appropriate in those 6 years of age or older with mild to moderate AOM.

Although amoxicillin has been given in a dosage of 40-45 mg/kg daily for 10 days for the treatment of AOM, the AAP, AAFP, US Centers for Disease Control and Prevention (CDC), and others recommend use of the higher amoxicillin dosage. The higher amoxicillin dosage (80-90 mg/kg daily) is especially important in patients with AOM known or suspected of being caused by Streptococcus pneumoniae with reduced susceptibility to penicillins and in patients with a history of anti-infective treatment of AOM within the previous few months.

Gonorrhea and Associated Infections
Some manufacturers state that adults and children weighing 40 kg or more may receive a single 3-g oral dose of amoxicillin for the treatment of acute, uncomplicated gonorrhea caused by susceptible nonpenicillinase-producing N. gonorrhoeae. and that children weighing less than 40 kg who are 2 years of age or older may receive a single 50-mg/kg (maximum 3 g) dose of oral amoxicillin given with a single 25-mg/kg (up to 1 g) oral dose of probenecid. However, penicillins are no longer included in CDC recommendations for the treatment of gonorrhea.

Lyme Disease
The Infectious Diseases Society of America (IDSA), AAP, and other clinicians consider amoxicillin a drug of choice for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of neurologic involvement or third-degree atrioventricular (AV) heart block. Amoxicillin is preferred for the treatment of early Lyme disease in pregnant or lactating women and in children younger than 8 years of age.

For the treatment of mild Lyme carditis manifested by first- or second-degree AV heart block, amoxicillin 500 mg 3 times daily for 14-21 days is recommended in adults; children younger than 8 years of age should receive amoxicillin 50 mg/kg daily in 3 divided doses (maximum dose: 500 mg).

For the treatment of Lyme arthritis without associated neurologic disease, amoxicillin 500 mg 3 times daily for 28 days is recommended in adults; children should receive amoxicillin 50 mg/kg daily (maximum: 1.5 g daily). For the treatment of early localized or early disseminated Lyme disease associated with erythema migrans in adults, amoxicillin 500 mg 3 times daily for 14-21 days is recommended; children younger than 8 years of age should receive amoxicillin 50 mg/kg daily (maximum: 1.5 g daily) in 3 divided doses.

Helicobacter pylori Infection
For the treatment of Helicobacter pylori (formerly Campylobacter pylori or C. pyloridis) infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults, the recommended dosage of amoxicillin is 1 g twice daily in combination with clarithromycin (500 mg twice daily) and lansoprazole (30 mg twice daily) for 14 days (triple therapy). When used in combination with clarithromycin (500 mg twice daily) and omeprazole (20 mg twice daily) for the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer), the recommended dosage of amoxicillin is 1 g twice daily for 10 days (triple therapy). An additional 18 days of omeprazole monotherapy is recommended for ulcer healing and symptom relief in patients with an active duodenal ulcer at the time therapy is initiated.

For the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults who are either allergic to or intolerant of clarithromycin or in whom resistance to clarithromycin is known or suspected, the recommended dosage of amoxicillin is 1 g 3 times daily in combination with lansoprazole 30 mg 3 times daily for 14 days (dual therapy).

When amoxicillin has been used in other multiple-drug regimens for the treatment of H. pylori infection and peptic ulcer disease in combination with at least one other agent that has activity against H. pylori, oral dosages of 500 mg 3 or 4 times daily (or 1 g 2 or 3 times daily) generally have been used; higher dosages of amoxicillin in such regimens reportedly have not been associated with improved results. Studies in which H. pylori was eradicated successfully generally have employed regimens consisting of a bismuth salt (e.g., bismuth subsalicylate), a nitroimidazole anti-infective (e.g., metronidazole), and another anti-infective agent (e.g., amoxicillin, tetracycline) or combined therapy with a proton-pump inhibitor (e.g., lansoprazole, omeprazole) and 1 or 2 anti-infective agents (e.g., clarithromycin, amoxicillin).
In a limited number of children with H. pylori-associated peptic ulcer disease (e.g., gastritis, duodenitis/ duodenal ulcer), oral amoxicillin 25-50 mg/kg daily in divided doses (e.g., 250-500 mg 3 times daily) has been administered as part of multiple-drug regimens that included a nitroimidazole anti-infective (e.g., metronidazole) and/or a bismuth salt (e.g., bismuth subsalicylate). Further study is needed to establish an optimal drug regimen for treatment of H. pylori infection in children.