Pediatric Amoxicillin Dosing for Tooth Infection
For pediatric tooth infections, amoxicillin should be dosed at 40-90 mg/kg/day divided into 2-3 doses for 7-10 days. 1
Recommended Dosing Regimen
Dose:
- Standard dose: 40-90 mg/kg/day 1
- For mild to moderate infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
- For severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
Frequency:
- Twice daily (every 12 hours) or three times daily (every 8 hours) 2
- Twice-daily dosing has similar efficacy to three-times daily dosing and may improve adherence 3
Duration:
- 7-10 days is the standard duration for dental infections 1
- Treatment should continue for at least 48-72 hours after the patient becomes asymptomatic 2
Special Considerations
Age-specific dosing:
- For children less than 12 weeks (3 months): Maximum dose of 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2
- For children 3 months and older: Follow standard dosing guidelines based on weight 2
Weight-based adjustments:
- For children weighing less than 40 kg: Use weight-based dosing as described above
- For children weighing 40 kg or more: Use adult dosing (500 mg twice daily or 250 mg three times daily) 2
Clinical Pearls
- Higher doses (75-90 mg/kg/day) may be needed for resistant organisms 4
- Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 2
- If the patient fails to respond within 48-72 hours, reassessment is necessary to confirm diagnosis or consider alternative antibiotics 1
Alternative Options for Penicillin-Allergic Patients
If the patient has a penicillin allergy, consider:
- Clindamycin: 7 mg/kg per dose three times daily (maximum = 300 mg per dose) for 10 days 1
- Cephalexin (if not an immediate hypersensitivity reaction): 20 mg/kg per dose twice daily (maximum = 500 mg per dose) for 10 days 1
Monitoring
- Assess clinical response within 48-72 hours of initiating treatment
- Continue treatment until at least 48-72 hours after symptoms resolve 2
- Complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and antibiotic resistance
Remember that establishing drainage (when applicable) is an essential component of treating dental infections, and antibiotics alone may not be sufficient without proper dental intervention.