What is the appropriate dose of amoxicillin 400mg/5ml for a 10-year-old child who weighs 70 pounds?

From the Guidelines

A 10-year-old child weighing 70 lbs (31.8 kg) should receive 572-1144 mg of amoxicillin per day, which translates to 14.3-28.6 mL per day of the 400 mg/5 mL suspension, divided into 2-3 doses, with a maximum dose of 4000 mg/day 1. The typical dosage for children is 90 mg/kg/day divided into 2 doses, as recommended by the most recent guidelines 1. For this child's weight, the calculated dose is 2862 mg per day, but the recommended dose range is 572-1144 mg per day, divided into 2-3 doses. When administering, shake the bottle well before each use. Use a medication syringe or dosing cup for accurate measurement. Complete the entire course of antibiotics as prescribed, even if symptoms improve before finishing. Some key points to consider:

• The dosing range allows for adjustment depending on the specific condition being treated, with higher doses used for more severe infections and lower doses for milder cases.
• The maximum dose of 4000 mg/day should not be exceeded 1.
• The treatment duration is typically 10 days, but this may vary depending on the severity of the infection and the clinical response to treatment.
• It is essential to follow the prescribed dosage and treatment duration to ensure effective treatment and minimize the risk of antibiotic resistance. The recommended dosage is based on the most recent guidelines for the treatment of pneumonia in children, which emphasize the importance of using evidence-based treatments to improve outcomes and reduce the risk of antibiotic resistance 1.

From the FDA Drug Label

Table 1 ... Weight Less than 40 kg ... 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours ... 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

For a 10-year-old child who weighs 70 pounds (approximately 31.8 kg), the dose would be calculated based on the weight.

• For mild/moderate infections: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours.
• For severe infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours. Given the child's weight (31.8 kg), the dose for mild/moderate infections would be approximately 795 mg/day (31.8 kg * 25 mg/kg) or 636 mg/day (31.8 kg * 20 mg/kg), and for severe infections, it would be approximately 1432 mg/day (31.8 kg * 45 mg/kg) or 1272 mg/day (31.8 kg * 40 mg/kg). To administer amoxicillin 400mg/5ml, the dose would need to be calculated based on these recommendations.
• For mild/moderate infections:
  • Every 12 hours: approximately 397.5 mg (795 mg / 2) or 2-3 teaspoons (10-15 ml) of the 400 mg/5 ml suspension.
  • Every 8 hours: approximately 212 mg (636 mg / 3) or approximately 1-2 teaspoons (5-10 ml) of the 400 mg/5 ml suspension.
• For severe infections:
  • Every 12 hours: approximately 716 mg (1432 mg / 2) or approximately 3.5-4 teaspoons (18-20 ml) of the 400 mg/5 ml suspension.
  • Every 8 hours: approximately 424 mg (1272 mg / 3) or approximately 2 teaspoons (10 ml) of the 400 mg/5 ml suspension. 2

From the Research

Amoxicillin Dosing for Children

To determine the appropriate dose of amoxicillin 400mg/5ml for a 10-year-old child who weighs 70 pounds, we need to consider the recommended dosing guidelines.

• The American Academy of Pediatrics recommends a dose of 80-90 mg/kg per day for the treatment of acute uncomplicated otitis media 3.
• A study published in 2021 found that oral amoxicillin syrup at a dose of 35-50 mg/kg/day compared with a dose of 70-90 mg/kg/day was effective in treating community-acquired pneumonia in children 4.
• However, another study published in 2024 found that larger children are often prescribed declining doses of amoxicillin in mg/kg/d, resulting in most patients above 60 kg being dosed at less than 40 mg/kg/d 5.
• A study published in 2004 compared the efficacy and tolerability of high-dose (80-90 mg/kg/d) versus standard-dose (40-45 mg/kg/d) amoxicillin among children with acute otitis media and found no significant difference in treatment success between the two groups 6.

Calculating the Appropriate Dose

Based on the recommended dose of 80-90 mg/kg per day, we can calculate the appropriate dose for a 10-year-old child who weighs 70 pounds (approximately 31.8 kg).

• The dose would be 80-90 mg/kg per day x 31.8 kg = 2544-2862 mg per day.
• Since amoxicillin 400mg/5ml is the available formulation, the dose would be approximately 2544-2862 mg per day / 400 mg per 5 ml = 6.36-7.16 ml per dose, assuming a three-times-daily dosing schedule.
• However, it's essential to note that the actual dose prescribed may vary depending on the specific clinical guidelines and the healthcare provider's professional judgment.

Considerations

• The dosing guidelines may vary depending on the specific infection being treated and the child's individual needs 4, 3, 6.
• The use of high-dose amoxicillin may be recommended for certain infections, such as pneumococcal infections, to ensure effective treatment 5, 3.
• It's crucial to follow the recommended dosing guidelines and consult with a healthcare provider to determine the appropriate dose for a specific child.