High-dose Amoxicillin

My 26-month-old, 26-pound daughter was diagnosed as having an ear infection. Her doctor put her on amoxicillin–500 mg, twice a day. Everyone is telling me that 1000 mg per day is an awful lot. What do you think?

High-dose Amoxicillin

Dr. Greene’s Answer:

The best dose of amoxicillin has changed in recent years. The change to high-dose amoxicillin came because many bacteria were getting partially resistant to it. Rather than switching to antibiotics that are broader spectrum or with more side effects, high-dose amoxicillin is considered the most effective and safest of the first line treatments.

The recommended dosage used to be 10 to 30 mg per kg of body weight per day. But for ear infections, it is now better to give 60 to 80 mg per kg per day. For her, that would be somewhere between 750 and 1000 mg daily. The timing between doses does not need to be precise, but the farther apart the doses are, the lower the chances of diarrhea as a side effect.

Generally speaking, amoxicillin is a very safe and well tolerated medication, even at the higher doses. However, antibiotics do kill beneficial bacteria as well, and the more effective the antibiotic, the more likely this will happen. Eating yogurt with active cultures is a great way to replenish them. Some of the frozen varieties are the most effective.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. CJ

    My ear nose and throat doctor told me that ear infections are usually a sign of dairy allergy or intolerance. After three years in a row with ear infections for my toddler and myself, I found this doctor, quit dairy and neither of us have had another ear infection.

    • AN

      I’ve found your information interesting as I’ve read recently that ear infections in children are often caused by second hand smoke. It makes sense to me now remembering how my little boy’s father used to smoke around him those many years ago and I used to wonder why those frequent ear infections. But it could be dairy too, never heard of it though…

  2. Sailu

    Please include my email in u r list . I got answers for couple of questions regarding antibiotics for kids . Great job Doctor Greene



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