Scope: soft-tissue infection without evidence of osteomyelitis. Probe-to-bone or exposed bone suggests osteomyelitis — treat as osteomyelitis (different workup and a longer course).
Alternative Initial TreatmentOR failed/recent Amoxicillin OR for sicker patients
Amoxicillin-Clavulanate
Use the 600 mg/42.9 mg/5 mL (120 mg/mL) [14:1] drug formulation to avoid overdosing on clavulanate
Max daily dosing for amoxicillin (±clavulanate) for otitis media is not consistent in the literature or with actual prescribing practices. Additionally, the literature certainly does not agree with drug labels. Please consider the following options we have found in literature: • Max 1750 mg/day amoxicillin component if q12h (same as adult) • Max 1500 mg/day amoxicillin component if q8h (same as adult) • Max 2,000 mg/day amoxicillin component • Max 3,000 mg/day amoxicillin component • Max 4,000 mg/day amoxicillin component We have provided this max dosing in our calculators.
90 mg/kg/day PO split q8h or q12h10 days if <24 mo or TM perforation; 5–7 days if ≥24 mo