# Acute otitis media - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO EML 2023 · Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (cefdinir monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Matz O, Sutton AE, Ashurst JV. Acute Otitis Media. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: June 8, 2026. · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (cefdinir monograph) - MSF Essential Drugs 2024 - paracetamol (oral) - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Matz O, Sutton AE, Ashurst JV. Acute Otitis Media. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: June 8, 2026. ## Treatment metadata - Amoxicillin — 500 mg — oral.solid - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Cefdinir — 300 mg — oral.solid - Azithromycin — 500 mg — oral.solid - Ceftriaxone — injection - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text ACUTE OTITIS MEDIA Sources: WHO EML 2023 · Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (cefdinir monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Matz O, Sutton AE, Ashurst JV. Acute Otitis Media. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: June 8, 2026. · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Ear pain is the most reliable clue, though many affected children show only vague symptoms [ear pain] - Ear pulling or tugging, irritability, headache, restless sleep, poor feeding, appetite loss, vomiting, or diarrhea are common [diarrhoea · headache · irritability · poor appetite · poor feeding · vomiting] - About two-thirds of affected children also run a fever, usually low-grade [fever] SIGNS - what you find (8) - Diagnostic criteria call for moderate to severe bulging of the eardrum, or new ear discharge unrelated to otitis externa [ear discharge] - Mild bulging with recent ear pain or redness can also support the diagnosis [ear pain · redness] - The eardrum may look red or normal, with reduced movement on insufflation from middle-ear fluid - Visible pus behind a bulging eardrum indicates suppurative disease [pus] - Marked swelling of the ear canal should raise suspicion for otitis externa instead - Mastoid swelling, redness, or tenderness out of proportion to the exam raises concern for mastoiditis [redness] - On Rinne testing, bone conduction sounds louder than air conduction - On Weber testing, sound lateralizes to the affected ear when there is conductive hearing loss [hearing loss] TESTS (8) - Labs are not routinely needed to diagnose AOM - A full sepsis work-up may be considered for infants under 12 weeks with fever and no clear source - Culturing ear discharge, especially from a fresh perforation or tympanocentesis, can guide antibiotic choice - Imaging is not routine for uncomplicated AOM and is reserved for suspected complications - CT of the temporal bones can find complications such as mastoiditis, abscess, or sinus thrombophlebitis - Tympanocentesis confirms middle-ear fluid and yields a sample for culture to guide targeted antibiotics - Tympanocentesis is generally reserved for newborns, immunocompromised patients, or antibiotic treatment failure - Tympanometry and acoustic reflectometry can detect middle-ear fluid but cannot reliably distinguish AOM from chronic suppurative disease IF NOT THIS - what else fits (8) - Fever without an identified source is an important differential, particularly in infants - Bacterial meningitis needs to be considered, especially in infants with nonspecific symptoms - Mastoiditis is a differential, and a key complication not to miss - Cholesteatoma is an important differential that should not be missed - Otitis externa is a key differential, especially when there is canal swelling - A common cold from rhinovirus infection is a differential - Pediatric reflux disease is on the differential list - Allergic rhinitis in children is a differential to consider Source StatPearls "Acute Otitis Media" - disease-level clinical article Status traced to the source above Rx: Antibiotic | Third-line antibiotic | If penicillin-allergic | When the child cannot keep oral antibiotics down | Pain and fever ANTIBIOTIC - choose one 1. AMOXICILLIN [1st line] Adult 500 mg TID x 5-7 days Peds 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).) 3kg -> 120-270 mg/day 4kg -> 160-360 mg/day 5kg -> 200-450 mg/day 6kg -> 240-540 mg/day 7kg -> 280-630 mg/day 8kg -> 320-720 mg/day 9kg -> 360-810 mg/day 10kg -> 400-900 mg/day 11kg -> 440-990 mg/day 12kg -> 480-1000 mg/day (upper capped) 13kg -> 520-1000 mg/day (upper capped) 14kg -> 560-1000 mg/day (upper capped) 15kg -> 600-1000 mg/day (upper capped) 16kg -> 640-1000 mg/day (upper capped) 17kg -> 680-1000 mg/day (upper capped) 18kg -> 720-1000 mg/day (upper capped) 19kg -> 760-1000 mg/day (upper capped) 20kg -> 800-1000 mg/day (upper capped) 21kg -> 840-1000 mg/day (upper capped) 22kg -> 880-1000 mg/day (upper capped) 23kg -> 920-1000 mg/day (upper capped) 24kg -> 960-1000 mg/day (upper capped) 25kg -> 1000 mg/day (capped) 26kg -> 1000 mg/day (capped) 27kg -> 1000 mg/day (capped) 28kg -> 1000 mg/day (capped) 29kg -> 1000 mg/day (capped) 30kg -> 1000 mg/day (capped) 31kg -> 1000 mg/day (capped) 32kg -> 1000 mg/day (capped) 33kg -> 1000 mg/day (capped) 34kg -> 1000 mg/day (capped) 35kg -> 1000 mg/day (capped) 36kg -> 1000 mg/day (capped) 37kg -> 1000 mg/day (capped) 38kg -> 1000 mg/day (capped) 39kg -> 1000 mg/day (capped) 40kg -> 1000 mg/day (capped) 41kg -> 1000 mg/day (capped) 42kg -> 1000 mg/day (capped) 43kg -> 1000 mg/day (capped) 44kg -> 1000 mg/day (capped) 45kg -> 1000 mg/day (capped) 46kg -> 1000 mg/day (capped) 47kg -> 1000 mg/day (capped) 48kg -> 1000 mg/day (capped) 49kg -> 1000 mg/day (capped) 50kg -> 1000 mg/day (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) Why High-dose amoxicillin (80-90 mg/kg/day) where pneumococcal resistance is likely. Caution Avoid in penicillin allergy. Reduce dose in severe renal impairment. A rash occurs if amoxicillin is given in glandular fever. Egypt AMOXYCILLIN 500MG 10 CAPS B.P.2013 ARAB DRUG COMPANY (ADCO) 6.50 EGP (0.65/unit) AMOXICILLIN 500MG 12 CAPS. USP 28 OCTOBER PHARMA 8.10 EGP (0.67/unit) AMOXIL 500MG 12 CAPS. MUP > SMITHKL... 9.00 EGP (0.75/unit) AMOXICID 500 MG 12 CAPS. CID 9.50 EGP (0.79/unit) E-MOX 500 MG 16 CAPS. EIPICO 15.60 EGP (0.97/unit) HICONCIL 500MG 12 CAPS. PHARCO 11.60 EGP (0.97/unit) BIOMOX 500MG 12 CAPS. SEDICO 19.50 EGP (1.62/unit) IBIAMOX 500 MG 12 CAPS. AMOUN 45.00 EGP (3.75/unit) HICILLIN 125MG/5ML SUSP. 80ML EL NASR 3.00 EGP -> ? strength differs, ? different route - not oral solid AMOXIL FORT 250MG/5ML SUSP. 60ML MUP > SMITHKL... 5.50 EGP -> ? strength differs, ? different route - not oral solid 2. AMOXICILLIN + CLAVULANIC ACID [2nd line] Adult 875 mg twice daily or 500 mg every 8 hours x 5-7 days Peds 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.) 3kg -> 240-270 mg/day 4kg -> 320-360 mg/day 5kg -> 400-450 mg/day 6kg -> 480-540 mg/day 7kg -> 560-630 mg/day 8kg -> 640-720 mg/day 9kg -> 720-810 mg/day 10kg -> 800-900 mg/day 11kg -> 880-990 mg/day 12kg -> 960-1080 mg/day 13kg -> 1040-1170 mg/day 14kg -> 1120-1260 mg/day 15kg -> 1200-1350 mg/day 16kg -> 1280-1440 mg/day 17kg -> 1360-1530 mg/day 18kg -> 1440-1620 mg/day 19kg -> 1520-1710 mg/day 20kg -> 1600-1800 mg/day 21kg -> 1680-1890 mg/day 22kg -> 1760-1980 mg/day 23kg -> 1840-2070 mg/day 24kg -> 1920-2160 mg/day 25kg -> 2000-2250 mg/day 26kg -> 2080-2340 mg/day 27kg -> 2160-2430 mg/day 28kg -> 2240-2520 mg/day 29kg -> 2320-2610 mg/day 30kg -> 2400-2700 mg/day 31kg -> 2480-2790 mg/day 32kg -> 2560-2880 mg/day 33kg -> 2640-2970 mg/day 34kg -> 2720-3060 mg/day 35kg -> 2800-3150 mg/day 36kg -> 2880-3240 mg/day 37kg -> 2960-3330 mg/day 38kg -> 3040-3420 mg/day 39kg -> 3120-3510 mg/day 40kg -> 3200-3600 mg/day 41kg -> 3280-3690 mg/day 42kg -> 3360-3780 mg/day 43kg -> 3440-3870 mg/day 44kg -> 3520-3960 mg/day 45kg -> 3600-4000 mg/day (upper capped) 46kg -> 3680-4000 mg/day (upper capped) 47kg -> 3760-4000 mg/day (upper capped) 48kg -> 3840-4000 mg/day (upper capped) 49kg -> 3920-4000 mg/day (upper capped) 50kg -> 4000 mg/day (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) Why 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. Caution Avoid in penicillin allergy. Diarrhoea is more common than with amoxicillin alone. Cholestatic jaundice can occur, and this combination is avoided if there has been a previous reaction. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid THIRD-LINE ANTIBIOTIC 3. CEFDINIR [3rd line] Adult Total daily dose 600 mg - as 300 mg twice daily or 600 mg once daily x 10 days Peds 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.) 3kg -> 42 mg/day 4kg -> 56 mg/day 5kg -> 70 mg/day 6kg -> 84 mg/day 7kg -> 98 mg/day 8kg -> 112 mg/day 9kg -> 126 mg/day 10kg -> 140 mg/day 11kg -> 154 mg/day 12kg -> 168 mg/day 13kg -> 182 mg/day 14kg -> 196 mg/day 15kg -> 210 mg/day 16kg -> 224 mg/day 17kg -> 238 mg/day 18kg -> 252 mg/day 19kg -> 266 mg/day 20kg -> 280 mg/day 21kg -> 294 mg/day 22kg -> 308 mg/day 23kg -> 322 mg/day 24kg -> 336 mg/day 25kg -> 350 mg/day 26kg -> 364 mg/day 27kg -> 378 mg/day 28kg -> 392 mg/day 29kg -> 406 mg/day 30kg -> 420 mg/day 31kg -> 434 mg/day 32kg -> 448 mg/day 33kg -> 462 mg/day 34kg -> 476 mg/day 35kg -> 490 mg/day 36kg -> 504 mg/day 37kg -> 518 mg/day 38kg -> 532 mg/day 39kg -> 546 mg/day 40kg -> 560 mg/day 41kg -> 574 mg/day 42kg -> 588 mg/day 43kg -> 600 mg/day (capped) 44kg -> 600 mg/day (capped) 45kg -> 600 mg/day (capped) 46kg -> 600 mg/day (capped) 47kg -> 600 mg/day (capped) 48kg -> 600 mg/day (capped) 49kg -> 600 mg/day (capped) 50kg -> 600 mg/day (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (cefdinir monograph) Why 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. Caution A third-generation oral cephalosporin in the formulary's WATCH group - it must not displace amoxicillin as first-line, which drives pneumococcal resistance. Iron preparations and antacids block absorption - separate by 2 hours; iron also turns the stools reddish, which is harmless but alarms parents. Once-daily dosing has not been studied in pneumonia or skin infection - those need twice-daily dosing. Egypt CEDENIR 300MG 10 CAPS. UNIPHARMA CO.... 45.00 EGP (4.50/unit) SPECTRACEFOCURE 300 MG 10 CAPS. KAHIRA > EVER... 45.00 EGP (4.50/unit) MERBACTADIN 300MG 10 CAPS. SHIFA MEDICAL... 52.50 EGP (5.25/unit) DENROCEF 300MG 10 CAPS. SHIFA MEDICAL... 67.50 EGP (6.75/unit) CEFATHIRD 300MG 10 CAPS. EGPI 90.00 EGP (9.00/unit) EGYNIR 300 MG 10 CAPS. SIGMA TEC PHA... 100.00 EGP (10.00/unit) OMNICEF 300 MG 10 CAP. AL JAZEERA PH... 232.00 EGP (23.20/unit) TORBENER 300MG 10 H.G. CAPS. UTOPIA PHARMA... 157.00 EGP CEDENIR 125MG/5ML DRY SUSP. UNIPHARMA CO.... 30.00 EGP -> ? strength differs, ? different route - not oral solid AVEROFECTAN 250MG/5ML SUSP. 60 ML SHIFA MEDICAL PRODUCTS > AVERROES PHAR... 32.00 EGP -> ? strength differs, ? different route - not oral solid IF PENICILLIN-ALLERGIC 4. AZITHROMYCIN [3rd line] Adult 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. Peds 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. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (azithromycin monograph) Why 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. Caution Rising macrolide resistance - reserve for penicillin allergy. The formulary's general paediatric regimen is 10-12 mg/kg on day 1 (max 500 mg) then 5-6 mg/kg once daily (max 250 mg). The flat five-day course here is the streptococcal- pharyngitis regimen and is deliberately different. Azithromycin prolongs the QT interval, so use caution with other QT-prolonging drugs. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid WHEN THE CHILD CANNOT KEEP ORAL ANTIBIOTICS DOWN 5. CEFTRIAXONE [3rd line] Adult 1 to 2 g once daily by intramuscular or intravenous injection x 3 days Peds 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.) 3kg -> 150 mg/day 4kg -> 200 mg/day 5kg -> 250 mg/day 6kg -> 300 mg/day 7kg -> 350 mg/day 8kg -> 400 mg/day 9kg -> 450 mg/day 10kg -> 500 mg/day 11kg -> 550 mg/day 12kg -> 600 mg/day 13kg -> 650 mg/day 14kg -> 700 mg/day 15kg -> 750 mg/day 16kg -> 800 mg/day 17kg -> 850 mg/day 18kg -> 900 mg/day 19kg -> 950 mg/day 20kg -> 1000 mg/day 21kg -> 1000 mg/day (capped) 22kg -> 1000 mg/day (capped) 23kg -> 1000 mg/day (capped) 24kg -> 1000 mg/day (capped) 25kg -> 1000 mg/day (capped) 26kg -> 1000 mg/day (capped) 27kg -> 1000 mg/day (capped) 28kg -> 1000 mg/day (capped) 29kg -> 1000 mg/day (capped) 30kg -> 1000 mg/day (capped) 31kg -> 1000 mg/day (capped) 32kg -> 1000 mg/day (capped) 33kg -> 1000 mg/day (capped) 34kg -> 1000 mg/day (capped) 35kg -> 1000 mg/day (capped) 36kg -> 1000 mg/day (capped) 37kg -> 1000 mg/day (capped) 38kg -> 1000 mg/day (capped) 39kg -> 1000 mg/day (capped) 40kg -> 1000 mg/day (capped) 41kg -> 1000 mg/day (capped) 42kg -> 1000 mg/day (capped) 43kg -> 1000 mg/day (capped) 44kg -> 1000 mg/day (capped) 45kg -> 1000 mg/day (capped) 46kg -> 1000 mg/day (capped) 47kg -> 1000 mg/day (capped) 48kg -> 1000 mg/day (capped) 49kg -> 1000 mg/day (capped) 50kg -> 1000 mg/day (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - verbatim: "General Adult Dosage IV or IM 1-2 g once or devided twice daily." Why 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. Caution Do not give it to a child who has had anaphylaxis to ceftriaxone, any cephalosporin, a penicillin or any other beta-lactam. This is a rescue route, not a replacement for the oral course - go back to oral amoxicillin as soon as the child can keep it down. Egypt CEFAXONE 250MG I.V. VIAL. PHARCO B 15.00 EGP CEFOTRIX 250MG I.V.VIAL (U.S.P.23) UP PHARMA 15.00 EGP TRIXOMASH 500MG VIAL FOR I.V. INJ. RAMEDA > MASH PREMIERE 16.50 EGP TRIAXONE 500MG VIAL FOR I.M. INJ. TABUK PHARMACEUTICAL MANUFACTURING COM... 36.00 EGP WINTRIAXONE 1 GM PD. FOR I.M INJ. SANOFI 48.00 EGP CEFTRIAXONE-SANDOZ 500 MG I.M. VIAL PHARCO B > SANDOZ 62.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP PAIN AND FEVER - give alongside 6. PARACETAMOL [add-on - not a substitute] Adult 1 g three or four times daily, maximum 4 g in 24 hours Peds 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.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why 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. Caution Give it at bedtime as well - disturbed sleep is usually what makes the parent come back. Check every other product the child is taking for paracetamol. Cold and flu sachets are the usual route to an accidental overdose. Reduce the maximum in liver disease, and in a child with severe acute malnutrition (10 mg/kg up to three times in 24 hours). 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 7. IBUPROFEN [add-on - not a substitute] Adult 200-400 mg up to three times daily with or after food, maximum 1200 mg in 24 hours Peds 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.) 3 to 5 months: 50 mg three times daily, and only over 5 kg. Not under 3 months. 6 to 11 months: 50 mg three to four times daily 1 to 3 years: 100 mg three times daily 4 to 6 years: 150 mg three times daily 7 to 11 years: 200 mg three times daily 12 years and over: The adult dose. 3kg -> 60 mg/day 4kg -> 80 mg/day 5kg -> 100 mg/day 6kg -> 120 mg/day 7kg -> 140 mg/day 8kg -> 160 mg/day 9kg -> 180 mg/day 10kg -> 200 mg/day 11kg -> 220 mg/day 12kg -> 240 mg/day 13kg -> 260 mg/day 14kg -> 280 mg/day 15kg -> 300 mg/day 16kg -> 320 mg/day 17kg -> 340 mg/day 18kg -> 360 mg/day 19kg -> 380 mg/day 20kg -> 400 mg/day 21kg -> 420 mg/day 22kg -> 440 mg/day 23kg -> 460 mg/day 24kg -> 480 mg/day 25kg -> 500 mg/day 26kg -> 520 mg/day 27kg -> 540 mg/day 28kg -> 560 mg/day 29kg -> 580 mg/day 30kg -> 600 mg/day 31kg -> 620 mg/day 32kg -> 640 mg/day 33kg -> 660 mg/day 34kg -> 680 mg/day 35kg -> 700 mg/day 36kg -> 720 mg/day 37kg -> 740 mg/day 38kg -> 760 mg/day 39kg -> 780 mg/day 40kg -> 800 mg/day 41kg -> 820 mg/day 42kg -> 840 mg/day 43kg -> 860 mg/day 44kg -> 880 mg/day 45kg -> 900 mg/day 46kg -> 920 mg/day 47kg -> 940 mg/day 48kg -> 960 mg/day 49kg -> 980 mg/day 50kg -> 1000 mg/day Choice 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. Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) Why 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. Caution Avoid in asthma, active peptic ulcer, dehydration or renal impairment, and in the third trimester of pregnancy. Do not give an NSAID in suspected chickenpox or dengue - both can present with fever, and both raise serious risk. With food. In a child aged 3-5 months seek advice if symptoms last beyond 24 hours. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)