From the Guidelines
For a 20 kg child requiring 90 mg per kilogram of amoxicillin per day, the appropriate total daily dose would be 1,800 mg (90 mg/kg × 20 kg), which should be divided into 2 doses of 900 mg each, as recommended by the Pediatric Community Pneumonia Guidelines 1. This dosing is commonly used for moderate to severe infections, such as otitis media, pneumonia, or sinusitis. The 90 mg/kg/day dosing is based on the guidelines for the management of community-acquired pneumonia in infants and children older than 3 months of age, which recommend amoxicillin as a preferred oral therapy for Streptococcus pneumoniae with MICs for penicillin ≤2.0 µg/mL 1. It's essential to complete the full prescribed course of antibiotics, usually 7-10 days, even if symptoms improve before then, to ensure effective bacterial killing and minimize the development of resistance. Amoxicillin is available in various formulations, including oral suspensions of different concentrations, so the volume to administer will depend on which concentration is dispensed. Some key points to consider when administering amoxicillin to children include:
- Weight-based dosing to ensure adequate blood levels for effective bacterial killing while minimizing side effects
- Completing the full prescribed course of antibiotics to prevent the development of resistance
- Monitoring for potential side effects, such as allergic reactions or gastrointestinal upset
- Using the appropriate formulation and concentration of amoxicillin to minimize the volume administered. The guidelines also recommend that doses for oral therapy should not exceed adult doses, and that treatment for the shortest effective duration will minimize exposure of both pathogens and normal microbiota to antimicrobials and minimize the selection for resistance 1. In cases where the child has a history of possible, nonserious allergic reactions to amoxicillin, treatment should be individualized, and options may include a trial of amoxicillin under medical observation or the use of alternative antibiotics, such as oral cephalosporins or macrolides 1.
From the Research
Amoxicillin Dosage Calculation
To determine the appropriate amount of amoxicillin for a 20 kg child who requires 90 mg per kilogram of amoxicillin per day, we can calculate the total daily dose as follows:
- Weight of the child: 20 kg
- Required dosage: 90 mg/kg/day
- Total daily dose: 20 kg * 90 mg/kg = 1800 mg
Administration Considerations
It's essential to note that the calculated dose should be divided into multiple administrations throughout the day, depending on the specific formulation and prescribing instructions. However, the provided studies do not offer specific guidance on the administration schedule for amoxicillin in pediatric patients 2, 3, 4, 5, 6.
Relevant Studies
While the studies do not directly address the calculation of amoxicillin dosage for pediatric patients, they do discuss the efficacy and safety of various antibiotics, including amoxicillin, in treating different infections 3, 5, 6. Additionally, one study reviews the spectrum and potency of orally administered cephalosporins and amoxicillin/clavulanate 6. Another study evaluates the activity of nine oral agents against gram-positive and gram-negative bacteria encountered in community-acquired infections 5.
Key Findings
- Amoxicillin/clavulanate was found to be active against a wide range of bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 5, 6.
- The studies do not provide specific dosage recommendations for pediatric patients, but they do highlight the importance of selecting the appropriate antibiotic based on the suspected or confirmed pathogen and the patient's individual needs 2, 3, 4, 5, 6.