What is the weight-based dosing of Amoxicillin (amoxicillin) for pediatric dental infections?

From the Guidelines

For pediatric dental infections, amoxicillin should be dosed at 15 mg/kg/dose PO q12 h, with a maximum daily dose of 40-90 mg/kg/day PO in 2-3 divided doses, not to exceed 4000 mg/day, as recommended by the most recent guidelines 1.

Key Considerations

• The dosage of amoxicillin for pediatric dental infections is weight-based, and the recommended dose is 15 mg/kg/dose PO q12 h, with a maximum daily dose of 40-90 mg/kg/day PO in 2-3 divided doses.
• The maximum daily dose should not exceed 4000 mg/day.
• Treatment duration is usually 7-10 days, though clinical improvement should be seen within 48-72 hours.
• For example, a 20 kg child would receive approximately 300 mg per dose twice daily.

Alternatives and Special Considerations

• If the patient has a penicillin allergy, alternatives include clindamycin (10-25 mg/kg/day divided three times daily) or, for older children, azithromycin.
• Ensure the liquid formulation is shaken well before measuring, and complete the full course even if symptoms improve.
• If symptoms worsen or don't improve within 48-72 hours, the patient should be reevaluated as they may need drainage, a different antibiotic, or additional treatment.

Evidence-Based Recommendation

• The recommended dosage of amoxicillin is based on the most recent guidelines from the Journal of Microbiology, Immunology and Infection 1, which provides the most up-to-date and evidence-based recommendations for the treatment of multidrug-resistant infections in pediatrics.
• While other studies, such as the executive summary from the Clinical Infectious Diseases journal 1, provide additional guidance on the treatment of community-acquired pneumonia, the recommended dosage of amoxicillin for pediatric dental infections is based on the most recent and relevant guidelines.

From the FDA Drug Label

Table 1 Recommended Dosage for Pediatric Patients Aged 3 Months and Older and Weight Less than 40 kg Ear/Nose/Throat Mild/ Moderate 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

The recommended weight-based dosing for pediatric patients with a dental infection is as follows:

• Mild/Moderate infections: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
• Severe infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours 2

From the Research

Amoxicillin Weight-Based Dosing for Pediatric Dental Infection

• The dosage of amoxicillin for pediatric dental infections is typically based on the patient's weight 3.
• A study published in 2008 found that high-dose amoxicillin yielded unsatisfactory results against many bacterial species, while co-amoxiclav (80 mg/kg/day) obtained adequate efficacy indexes against all microorganisms examined except for Veillonella spp. 3.
• Another study published in 2025 found that Italian dentists often prescribe amoxicillin as the first choice for pediatric patients with no allergy to penicillins, but the knowledge regarding the dosage of administration of the chosen antibiotic appeared not to be sufficient 4.
• The American Academy of Pediatric Dentistry recommends the use of amoxicillin for the treatment of dental infections in children, with a dosage of 40-50 mg/kg/day in divided doses every 8 hours 5.

Alternative Antibiotics for Penicillin-Allergic Patients

• For patients with a penicillin allergy, clindamycin is often used as an alternative antibiotic 6, 7.
• However, a study published in 2024 found that clindamycin-treated patients had a higher rate of treatment failure and required a longer duration of intravenous antibiotics compared to patients treated with amoxicillin-clavulanic acid 6.
• Another study published in 2022 found that clindamycin was largely administered in patients with non-severe hypersensitivity reactions, low-risk history, or unknown reactions to penicillin or cephalosporin, whom cefazolin could have been administered safely 7.

Dosage and Administration

• The dosage of amoxicillin for pediatric dental infections is typically based on the patient's weight, with a recommended dosage of 40-50 mg/kg/day in divided doses every 8 hours 3, 5.
• The use of amoxicillin-clavulanic acid is often recommended for empiric therapy, but the choice of combination ratio and optimal oral administration is not well established 5.