What is the recommended dose of amoxicillin (amoxicillin) for a 5-year-old child with an acute illness such as otitis media or pneumonia?

From the Guidelines

For a 5-year-old child with an acute illness such as otitis media or pneumonia, the recommended dose of amoxicillin is 90 mg/kg/day in 2 doses. This dosing is based on the most recent and highest quality study available, which is the 2011 clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1. According to these guidelines, for children ≥ 5 years old, oral amoxicillin is recommended at a dose of 90 mg/kg/day in 2 doses, with a maximum dose of 4 g/day.

Key Considerations

• The dose of 90 mg/kg/day is recommended for presumed bacterial pneumonia, and it is essential to note that the dosage may vary depending on the severity of the infection and local susceptibility data.
• For a typical 5-year-old weighing about 18-20 kg, this would translate to approximately 800-900 mg twice daily.
• The duration of treatment is usually 7-10 days for otitis media and 7-14 days for pneumonia, depending on severity and clinical response.
• It's crucial to complete the full course of antibiotics even if symptoms improve before completion.
• Amoxicillin should be given with or without food, though taking it with food may help reduce stomach upset.
• Parents should be aware of potential side effects including diarrhea, rash, and allergic reactions.

Special Considerations

• If the child has a history of penicillin allergy, amoxicillin should not be used, and alternative antibiotics should be prescribed.
• For children with bacteremic pneumococcal pneumonia, particular caution should be exercised in selecting alternatives to amoxicillin, given the potential for secondary sites of infection, including meningitis.
• The guidelines also recommend that for children with presumed bacterial CAP who do not have clinical, laboratory, or radiographic evidence that distinguishes bacterial CAP from atypical CAP, a macrolide can be added to a β-lactam antibiotic for empiric therapy 1.

In contrast to older guidelines, such as those from the British Thoracic Society in 2002 1, which recommended amoxicillin as the first choice for oral antibiotic therapy in children under the age of 5 years, the more recent guidelines provide a clear dosing recommendation for children ≥ 5 years old. Therefore, the recommendation of 90 mg/kg/day in 2 doses is based on the most recent and highest quality evidence available.

From the Research

Amoxicillin Dosing for a 5-Year-Old with an Acute Illness

The recommended dose of amoxicillin for a 5-year-old child with an acute illness such as otitis media or pneumonia can vary depending on the specific circumstances.

• For acute otitis media, high-dose amoxicillin (70 to 90 mg/kg/day) is recommended as first-line therapy in geographic areas where drug-resistant Streptococcus pneumoniae is prevalent 2.
• However, if the local prevalence of nonsusceptible Streptococcus pneumoniae is low, standard-dose amoxicillin (35-45 mg/kg per day) may be sufficient 3.
• The dosing frequency of amoxicillin can also be considered, with twice-daily dosing being a feasible alternative to three times daily dosing 4, 5.
• It's worth noting that other antibiotics, such as clarithromycin, may also be effective in treating acute otitis media in children 6.

Factors to Consider

When determining the appropriate dose of amoxicillin for a 5-year-old child, several factors should be considered, including:

• The severity of the illness
• The presence of drug-resistant bacteria in the community
• The child's weight and age
• The potential for side effects and interactions with other medications
• The feasibility of different dosing regimens in terms of compliance and effectiveness 2, 3, 4, 5.