What is the recommended dose of amoxicillin (amoxicillin) for strep throat?

Amoxicillin Dosing for Strep Throat

For strep throat (Group A Streptococcal pharyngitis), amoxicillin should be given at 50 mg/kg once daily (maximum 1,000 mg) or alternatively 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days. 1

Recommended Dosing Regimens

Children:

• First-line option: 50 mg/kg once daily (maximum 1,000 mg) for 10 days 1
• Alternative option: 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1

Adolescents and Adults:

• 500 mg twice daily for 10 days 1

Why Amoxicillin for Strep Throat?

Amoxicillin is an excellent choice for strep throat treatment because:

• It has comparable efficacy to penicillin V (the traditional gold standard) 2, 3
• Once-daily dosing improves compliance compared to multiple daily doses 2
• It has a more palatable taste than penicillin V suspension (important for children) 1
• It has a narrow antimicrobial spectrum, minimizing disruption to normal flora 1

Duration of Therapy

The 10-day duration is critical and strongly recommended with high-quality evidence 1. This duration is specifically designed to:

• Ensure complete eradication of Group A Streptococcus
• Prevent acute rheumatic fever, a potentially serious complication 4

Common Pitfalls to Avoid

1. Insufficient treatment duration: Although shorter courses (5-7 days) have been studied 5, the 10-day regimen remains the standard recommendation to prevent rheumatic fever 1.

2. Inadequate dosing: Underdosing may lead to treatment failure and potential complications.

3. Not completing the full course: Patients often stop antibiotics when symptoms improve, usually within 24-48 hours. Emphasize the importance of completing the full 10-day course even after symptoms resolve.

4. Not considering penicillin allergy: For penicillin-allergic patients, alternative regimens include:

   • Cephalexin: 20 mg/kg twice daily (maximum 500 mg per dose) for 10 days (avoid in immediate hypersensitivity to penicillin) 1
   • Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1

5. Not addressing chronic carriers: Different regimens are needed for chronic carriers of Group A Streptococcus 1.

Administration Considerations

• Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 4
• Shake oral suspension well before using 4
• Refrigeration of reconstituted suspension is preferable but not required 4

Remember that even though symptoms typically resolve within 3-4 days with or without treatment, completing the full 10-day course is essential to prevent complications, particularly acute rheumatic fever.