From the Guidelines
The maximum daily dose of amoxicillin should not exceed 4 grams (4000 mg) per day, as stated in the guidelines for pediatric community-acquired pneumonia treatment 1. When determining the appropriate dose of amoxicillin, it is essential to consider the patient's age, weight, and the severity of the infection.
- For children older than 3 months, the recommended dose is 90 mg/kg/day in 2 doses, with a maximum of 4 g/day 1.
- The dosage may vary depending on the specific infection being treated and the patient's medical history, such as allergies or kidney impairment.
- It is crucial to maintain adequate blood levels of the antibiotic to effectively kill bacteria, while minimizing the risk of side effects, such as diarrhea, nausea, and allergic reactions.
- Patients should always complete the full prescribed course of antibiotics, even if symptoms improve before finishing the medication, to ensure the infection is fully cleared and reduce the risk of antibiotic resistance.
- The guidelines also emphasize the importance of considering local susceptibility data when selecting antibiotic therapy, and adjusting the dose accordingly 1.
From the FDA Drug Label
In Adults, 750 to 1750 mg/day in divided doses every 8 to 12 hours. In Pediatric Patients over 3 Months of Age, 20 to 45 mg/kg/day in divided doses every 8 to 12 hours. The upper dose for neonates and infants aged 3 months or younger is 30 mg/kg/day divided every 12 hours. The maximum dose of amoxicillin per day is 1750 mg for adults and 45 mg/kg for pediatric patients over 3 months of age 2, 2.
- For adults, the dose can be divided every 8 to 12 hours.
- For pediatric patients, the dose can also be divided every 8 to 12 hours.
- For neonates and infants aged 3 months or younger, the maximum dose is 30 mg/kg per day, divided every 12 hours.
From the Research
Amoxicillin Dosage
- The maximum dose of amoxicillin per day is not explicitly stated in the provided studies, but dosages of up to 2.2 g every 6-8 hours are suggested in certain cases 3.
- A study from 1997 found that dosing amoxicillin/clavulanate every 12 hours (875/125 mg) was as effective as dosing every 8 hours (500/125 mg) for the treatment of lower respiratory tract infections 4.
- Another study from 2024 evaluated the use of oral amoxicillin/clavulanate for urinary tract infections caused by ceftriaxone non-susceptible Enterobacterales, but did not specify a maximum daily dose 5.
- The pharmacokinetics of amoxicillin and clavulanic acid are altered in patients with impaired renal function, and dosage adjustments may be necessary to prevent undue accumulations of amoxicillin 6.
Factors Affecting Dosage
- Renal function is an important factor in determining the dosage of amoxicillin, as impaired renal function can lead to decreased clearance and increased accumulation of the drug 6.
- The use of renal replacement therapy (RRT) can also affect the pharmacokinetics of amoxicillin and clavulanic acid, and careful consideration of antibiotic dose and frequency is required in critically ill patients receiving RRT 3.
- The risk of nephrotoxicity associated with amoxicillin use should also be considered when determining the dosage, particularly in patients with pre-existing renal impairment 7.