What is the recommended dose of amoxicillin (amoxicillin) for a 63kg pediatric patient with bronchitis?

From the Guidelines

For a 63kg pediatric patient with bronchitis, the recommended dose of amoxicillin is 90 mg/kg/day in 2 doses, which equals approximately 5,670 mg per day or 2,835 mg twice daily, with a maximum dose of 4 g/day.

Important Considerations

• The dosage is based on the guidelines for community-acquired pneumonia, as there is no specific guideline provided for bronchitis in the given evidence 1.
• It's crucial to note that the patient's weight and the severity of the infection should be taken into account when determining the dosage.
• The medication should be taken with food to reduce stomach upset.
• If the patient has a penicillin allergy, alternative antibiotics should be considered, such as azithromycin or clarithromycin, as outlined in the guidelines for community-acquired pneumonia 1.
• Parents should monitor for side effects, including diarrhea, rash, or signs of allergic reaction.
• If symptoms worsen or don't improve after 48-72 hours of treatment, the patient should be reassessed, as this could indicate viral bronchitis (which doesn't respond to antibiotics) or the need for a different antibiotic.

Key Points to Consider

• The patient's age and weight should be considered when determining the dosage, as the guidelines provide different recommendations for children under 5 years old and those 5 years old and older 1.
• The guidelines recommend a maximum dose of 4 g/day for amoxicillin, which should not be exceeded 1.
• The treatment duration is typically 5-7 days, but this may vary depending on the severity of the infection and the patient's response to treatment.
• It's essential to complete the full course of antibiotics, even if symptoms improve before completion, to ensure that the infection is fully cleared.

From the FDA Drug Label

Table 1 ... Lower Respiratory Tract Mild/ Moderate or Severe 875 mg every 12 hours or 500 mg 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 63kg pediatric patient, the dose would be calculated as follows:

• 45 mg/kg/day in divided doses every 12 hours: 45 mg/kg * 63 kg = 2835 mg per day, which can be divided into 2 doses of approximately 1417.5 mg every 12 hours.
• 40 mg/kg/day in divided doses every 8 hours: 40 mg/kg * 63 kg = 2520 mg per day, which can be divided into 3 doses of approximately 840 mg every 8 hours.

Given the patient's weight is above 40 kg, the recommended dose for Lower Respiratory Tract infections is 875 mg every 12 hours or 500 mg every 8 hours. However, for pediatric patients above 40 kg, the dosage is usually capped at the adult dose. The dose for this patient would be 875 mg every 12 hours or 500 mg every 8 hours 2.

From the Research

Amoxicillin Dosing for Pediatric Bronchitis

• The recommended dose of amoxicillin for a 63kg pediatric patient with bronchitis is not explicitly stated in the provided studies.
• However, study 3 suggests that amoxicillin can be effective at a dose of 35-50 mg/kg/day or 70-90 mg/kg/day for the treatment of community-acquired pneumonia in children.
• For a 63kg child, the dose would be approximately 2205-3150 mg/day for the lower dose range and 4410-5670 mg/day for the higher dose range, divided into 2-3 doses per day.
• Study 4 compared two daily doses of 1000 mg amoxycillin with three daily doses of 750 mg in patients with bronchitis, and found similar cure rates and side effects.
• Study 5 compared 5-day treatment with cefuroxime axetil to 10-day treatment with amoxicillin-clavulanate in patients with acute bronchitis, and found that the shorter treatment was as effective as the longer treatment.
• Study 6 compared azithromycin to amoxicillin/clavulanic acid in patients with acute purulent exacerbation of chronic bronchitis, and found that amoxicillin/clavulanic acid was more effective.

Considerations for Treatment Duration

• Study 7 suggests that short-course antimicrobial therapy (<=5 days) may be as effective as traditional longer therapies (10-14 days) for respiratory tract infections, including bronchitis.
• Study 5 found that 5-day treatment with cefuroxime axetil was as effective as 10-day treatment with amoxicillin-clavulanate in patients with acute bronchitis.
• Study 3 found that 3-day treatment with amoxicillin was non-inferior to 7-day treatment in children with community-acquired pneumonia.