# Recurrent acute otitis media (grommet referral) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/ · Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/ · Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-full.txt) · Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph). The formulary 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 weight table. · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin. · MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg. - Verified date: 2026-08 ## Verified against - Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/ - Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/ - Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-full.txt) - Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) - MSF Essential Drugs 2024 - paracetamol (oral) - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph). The formulary 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 weight table. - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin. - MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg. ## Treatment metadata - Amoxicillin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text RECURRENT ACUTE OTITIS MEDIA (GROMMET REFERRAL) Sources: Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/ · Otitis Media With Effusion - StatPearls (NCBI Bookshelf NBK538293) - https://www.ncbi.nlm.nih.gov/books/NBK538293/ · Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis-media-full.txt) · Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis- media-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph). The formulary 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 weight table. · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin. · MSF Essential Drugs 2024 - paracetamol (oral): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg. Review status: REVIEWED against 7 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Ear pain is the single most reliable clue, though many affected children instead show vague, nonspecific signs. [ear pain] - Common nonspecific clues include tugging at the ear, irritability, headache, poor sleep, poor feeding, appetite loss, vomiting, or diarrhea. [diarrhoea · headache · insomnia · irritability · poor appetite · poor feeding · vomiting] - About two-thirds of affected children also run a low-grade fever. [fever] - Any age is possible, but the peak sits between 6 and 24 months - It is the commonest reason a child is given an antibiotic, and yet most episodes settle without one SIGNS - what you find (8) - Diagnosis needs either moderate-to-severe bulging of the eardrum or new drainage from the ear that isn't from an outer-ear infection. - Mild bulging can still count if it's paired with recent ear pain or redness. [ear pain · redness] - On otoscopy the drum can look red or normal, with fluid behind it and less movement to a puff of air; clearly bulging pus points to suppurative disease. [pus] - Marked swelling of the ear canal itself suggests a coexisting outer-ear infection rather than AOM alone. - Swelling, redness, or unusual tenderness over the mastoid bone behind the ear raises concern for mastoiditis. [redness] - On tuning-fork testing, bone conduction sounds louder than air conduction on the affected side. - Puffing air at the drum is the most reliable way to judge it, and beats plain otoscopy on both sensitivity and specificity - Red flag: undertreated it can end in hearing loss, unsteadiness, a perforated drum, cholesteatoma, and rarely mastoiditis, labyrinthitis, meningitis, brain abscess or sinus thrombosis [abscess · hearing loss · unsteadiness] TESTS (7) - The typical case is diagnosed without any lab work or imaging. - A full sepsis workup may be reasonable for a febrile infant under 12 weeks with no clear source, even though AOM alone doesn't call for it. - Temporal bone CT can pick up complications like mastoiditis, abscess, sinus clotting, meningitis, or cholesteatoma. - Draining fluid from the eardrum confirms the effusion and lets the fluid be cultured to target antibiotics. - That drainage procedure is generally reserved for newborns, immunocompromised patients, or cases where antibiotics have failed or disease is severe. - Tympanometry can pick up middle ear fluid but can't reliably tell simple AOM apart from chronic suppurative disease; hearing testing is more useful for recurrent or complicated cases. - What makes the call hard: two examiners disagree, the child will not cooperate, and the canal is narrow IF NOT THIS - what else fits (4) - Cholesteatoma and fever without any clear source also appear on the AOM differential list. - Bacterial meningitis in a child is another differential to keep in mind for this presentation. - Both the common cold and teething are listed among conditions considered alongside AOM. - The middle ear runs a spectrum, and which point it sits at changes what you do: acute, recurrent, with effusion, or chronic suppurative Source Recurrent acute otitis media - disease-level clinical article (recurrent-acute-otitis- media-full.txt) Status traced to the source above Rx: Antibiotic for the acute episode | Main treatment | Antibiotic when amoxicillin has not worked | Pain and fever ANTIBIOTIC FOR THE ACUTE EPISODE 1. AMOXICILLIN [1st line] Adult 500 mg three times daily x 10 days, which is the course the article gives for acute otitis media in adults and children alike Peds 40-90 mg/kg/day [child max 1000 mg] (Divided twice or three times daily; use the high end, 80 to 90 mg/kg/day, where pneumococcal resistance is likely, which is the usual assumption in a child who keeps relapsing. The 1,000 mg per day ceiling is the formulary's 500 mg per-dose limit at the twice- daily schedule.) 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). The formulary 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 weight table. Why The article makes high-dose oral amoxicillin the antibiotic of choice for a bacterial episode in anyone not allergic to penicillin, on the grounds of the concentration it reaches in the middle ear. Recurrence is not a reason to escalate the agent - each episode is treated as an episode, while the recurrence itself is what earns the surgical referral. The dose here is the same one the acute otitis media card carries, so the two cards cannot drift into two answers. Caution Avoid in penicillin allergy. The article's alternatives there are a single 10 mg/kg dose of azithromycin, clarithromycin 15 mg/kg/day in 2 divided doses, cefdinir 14 mg/kg/day, cefpodoxime 10 mg/kg once daily or cefuroxime 30 mg/kg/day in 2 divided doses. PROPHYLACTIC ANTIBIOTICS ARE NO LONGER ADVISED for recurrent acute otitis media. The article says so directly, and sends the child for assessment for tympanostomy tubes instead - so a long low-dose course is the thing not to start here. Reassess at 48 to 72 hours if a child is not responding, which is the article's own interval for reconsidering treatment. Where the eardrum has perforated, the article treats with an ototopical antibiotic safe for middle ear use, such as ofloxacin drops, rather than a systemic antibiotic, because the drops reach far higher concentrations locally. The same applies to a child with functioning grommets who gets an episode, and to uncomplicated discharge from a grommet, for which it prescribes ear drops alone. Reduce the dose in severe renal impairment, and expect a rash if amoxicillin is given during 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 MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Count the episodes: three in six months, or four or more in twelve, is the AAP threshold for an ENT referral to consider grommets. Treat each episode from the acute otitis media entry and reassess at 48 to 72 hours if it has not answered. Do not put the child on months of prophylactic antibiotics - that is no longer advised. Time the referral to the pattern, because a grommet must not be inserted in an ear with no effusion on the day of assessment. Check hearing and speech, not just the drum. Send back sooner for unsettling fever, worsening pain, changed hearing or behaviour, or swelling behind the ear. Source Acute Otitis Media - StatPearls (NCBI Bookshelf NBK470332) - https://www.ncbi.nlm.nih.gov/books/NBK470332/ Why Counting the episodes is what turns repeated earache into an ENT referral. A single episode is treated on the acute-otitis-media entry; what belongs here is the threshold for grommets, the fact that long-term antibiotics are no longer the answer, and the modifiable risks worth naming to the family in the meantime. Caution THE COUNT THAT TRIGGERS THE REFERRAL - by the AAP guidelines, a child who has had 3 episodes of acute otitis media within 6 months, or 4 or more within 12 months, should be considered for myringotomy and grommet insertion (tympanostomy). DO NOT PUT THE CHILD ON MONTHS OF ANTIBIOTICS INSTEAD - prophylactic antibiotics are NO LONGER advised for a child with recurrent acute otitis media; assess for grommets instead. AND THE EAR HAS TO BE WET ON THE DAY THE ENT SURGEON LOOKS - a grommet must NOT be inserted in a child with recurrent acute otitis media who has no middle ear effusion in either ear when they are assessed for it. An ear that is dry at the appointment can lose the child the operation, so time the referral to the pattern of episodes. WHY THE TUBE HELPS - repeated infections needing antibiotics are, clinically, evidence that the Eustachian tube is not working. A grommet ventilates the middle ear space, brings hearing back to normal, and heads off delay in speech. And a child with a grommet in place who catches another infection can be treated with antibiotic ear drops instead of another course by mouth. COUNT PROPERLY, BECAUSE THE NUMBER PREDICTS THE COURSE - a child who has had fewer than 3 episodes is about 3 times likelier to get better on a single course of antibiotic. RECHECK AT 48 TO 72 HOURS DURING AN EPISODE - a paediatric infection that has not answered the first antibiotic inside 48 to 72 hours is reassessed, with a view to changing the treatment. And where antibiotics are held back in favour of watchful waiting, agree a fallback plan for starting them. THE MODIFIABLE RISKS WORTH NAMING TO THE FAMILY - keeping up with the pneumococcal and influenza vaccines cuts down the upper respiratory infections that so often come before an episode. Carers should also keep the child away from tobacco smoke, second-hand and third-hand alike, which irritates the airway and raises the risk of infection. And breastfeeding, where it is possible, goes with less otitis media, because protective immunoglobulins pass to the child. THE RISKS THAT CANNOT BE CHANGED, BUT EXPLAIN THE PATTERN - no breastfeeding, or not for long. Exposures in the environment - passive smoking, and being in daycare. A lower socioeconomic position. Recurrent acute otitis media in the family, in a parent or a sibling. And an abnormality of the skull or the palate that stops the Eustachian tube working - a cleft palate, or a tensor veli palatini that does not function. AND ONE RISK IS AGE, WHICH THE CHILD GROWS OUT OF - the peak falls at 6 to 12 months of age, and the rate drops away after 5 years, as the angle of the Eustachian tube changes. FLUID BETWEEN EPISODES IS A DIFFERENT PROBLEM WITH THE SAME TREATMENT - a persistent effusion shows on otoscopy as thick amber fluid behind a retracted drum. Both conditions reduce the drum's mobility on tympanometry or pneumatic otoscopy and both cost hearing, which is exactly why one gets mistaken for the other and managed wrongly. STEROIDS AND ANTIHISTAMINES ARE NOT THE ANSWER TO EITHER - neither a systemic steroid nor an antihistamine has been shown to help meaningfully. CHECK THE HEARING AND THE SPEECH, NOT JUST THE DRUM - a referral for speech and language may be needed where delay persists, and particularly after grommets have gone in. Repeated infections in the first years cost a child hearing at the age they are learning to talk. WHEN TO SEND THE CHILD BACK SOONER - fever that will not settle, ear pain getting worse, or any change in hearing or in behaviour, all warrant review. Add to that a swelling or redness behind the ear, which is mastoiditis until proven otherwise. ANTIBIOTIC WHEN AMOXICILLIN HAS NOT WORKED 3. AMOXICILLIN + CLAVULANIC ACID [2nd line] Adult 875 mg twice daily, or 500 mg every 8 hours x 10 days Peds 80-90 mg/kg/day [child max 4000 mg] (Of the amoxicillin component, divided twice daily. Use a 14:1 formulation such as AUGMENTIN ES-600 or a 642.9 mg/5 mL suspension, so that clavulanate stays under 10 mg/kg/day at this amoxicillin dose; a 7:1 product at the same amoxicillin dose delivers far too much clavulanate. The article's figure for the clavulanate component at this regimen is 6.4 mg/kg/day.) 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) for the amounts. The card's own article puts the same regimen at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, in 2 divided doses, for a child whose symptoms have not improved on high-dose amoxicillin. Why Beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis are what defeat plain amoxicillin, and they are commoner in a child who has already had several courses. The article's step after high-dose amoxicillin fails is high-dose amoxicillin- clavulanate, and the dose here is the one the acute otitis media card already carries. Caution Avoid in penicillin allergy, and avoid entirely if there has been previous cholestatic jaundice with this combination. Diarrhoea is commoner than with amoxicillin alone, and at 90 mg/kg/day it is the usual reason a course is abandoned. Check the ratio on the bottle before writing the dose. This is the one place a paediatric otitis prescription goes wrong. For a child who cannot keep an oral antibiotic down, the article's alternative is ceftriaxone 50 mg/kg/day intravenously or intramuscularly for 3 consecutive days. The article records that systemic steroids and antihistamines have not been shown to help acute otitis media. 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 PAIN AND FEVER - give alongside 4. PARACETAMOL [add-on - not a substitute] Adult 1 g three or four times daily, maximum 4 g in 24 hours - Through the painful days of each episode, including at bedtime 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 per day. Under 1 month, 10 mg/kg per dose three or four times daily, maximum 40 mg/kg per day. In severe acute malnutrition MSF reduces it to 10 mg/kg up to three times in 24 hours.) 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): adult 1 g 3 or 4 times daily, maximum 4 g daily; child 1 month and over 15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily; child under 1 month 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg daily. The 500 mg per-dose ceiling is MSF's own top paediatric band, one 500 mg tablet three times daily from 30 to under 50 kg. Why The article makes controlling the pain one of the two goals of treating an episode, and names acetaminophen, non-steroidal anti-inflammatory drugs or topical 1% lidocaine, used alone or together, for it. In a child having their fourth episode in a year the pain and the broken nights are what the family came about. Caution Give it at bedtime as well - the disturbed sleep is usually what brings the family 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. Three episodes in 6 months, or four or more in 12 months, is the article's threshold for assessing a child for grommets - and it adds that tubes are not inserted if there is no middle ear effusion in either ear at the time of that assessment, while bilateral tubes are placed where effusion is present. Recurrent episodes are evidence of Eustachian tube dysfunction, and the article's reason for tubes is ventilation of the middle ear, return of normal hearing and prevention of speech delay. Hearing or speech concerns need audiology, not another antibiotic. 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 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)