What are the recommended medications and dosages for treating acute illnesses in children?

Recommended Medications and Dosages for Treating Acute Illnesses in Children

For pediatric patients with acute illnesses, medication selection should be pathogen-specific with appropriate weight-based dosing to maximize efficacy while minimizing antibiotic resistance and adverse effects. 1

Community-Acquired Pneumonia (CAP)

Outpatient Management

• First-line (mild CAP):
  • Amoxicillin 90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses 1, 2
  • Treatment duration: 10 days (standard), though shorter courses may be effective for mild cases 1

Inpatient Management

• Non-severe CAP:
  • Ampicillin 150-200 mg/kg/day IV divided every 6 hours 1
• Severe CAP or concern for resistant organisms:
  • Ceftriaxone 50-100 mg/kg/day IV every 12-24 hours 1
• If Mycoplasma/Chlamydia suspected:
  • Add azithromycin 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 1, 3
• If MRSA suspected:
  • Add vancomycin 40-60 mg/kg/day IV divided every 6-8 hours or clindamycin if susceptible 1

Acute Otitis Media

• First-line:
  • Amoxicillin 90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses 2
  • Alternative dosing:
    • Single dose: 30 mg/kg as one-time dose 3
    • 3-day course: 10 mg/kg/day for 3 days 3
    • 5-day course: 10 mg/kg on day 1, then 5 mg/kg/day for days 2-5 3
• For beta-lactamase producing organisms:
  • Amoxicillin-clavulanate (amoxicillin component 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses) 1

Acute Bacterial Sinusitis

• First-line:
  • Amoxicillin 45 mg/kg/day in divided doses every 12 hours 2
  • Alternative: Azithromycin 10 mg/kg/day for 3 days 3
• For beta-lactamase producing organisms:
  • Amoxicillin-clavulanate (amoxicillin component 45 mg/kg/day in 3 doses) 1

Pharyngitis/Tonsillitis

• Group A Streptococcal infection:
  • Amoxicillin 50-75 mg/kg/day in 2 doses for 10 days 1, 2
  • Alternative: Azithromycin 12 mg/kg once daily for 5 days 3

Weight-Based Dosing Considerations

Azithromycin Weight-Based Dosing

For children ≤40 kg:

• 5-11 kg: 10 mg/kg day 1, then 5 mg/kg days 2-5 (total 150 mg)
• 12-22 kg: 10 mg/kg day 1, then 5 mg/kg days 2-5 (total 300 mg)
• 23-44 kg: 10 mg/kg day 1, then 5 mg/kg days 2-5 (total 600 mg)
• ≥45 kg: Adult dosing 3

Amoxicillin Weight-Based Dosing

• Mild/moderate infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours
• Severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
• For infants <12 weeks: Maximum 30 mg/kg/day divided every 12 hours due to immature renal function 2

Principles for Prescribing in Children

1. Use appropriate weight-based dosing - Children require careful dose calculations based on weight, not simply reduced adult doses 4

2. Limit antibiotic exposure - Use the narrowest spectrum antibiotic effective against the suspected pathogen to minimize resistance development 1

3. Adjust for renal function - For children with impaired renal function (GFR <30 mL/min), dose adjustments are necessary 2

4. Consider age-appropriate formulations - Liquid formulations are often needed for younger children 5

5. Treat for appropriate duration - Standard 10-day courses are recommended for streptococcal infections to prevent rheumatic fever, but shorter courses may be appropriate for other conditions 1, 2

Common Pitfalls to Avoid

• Overprescribing antibiotics - Up to 11.4 million unnecessary antibiotic prescriptions are written annually for pediatric acute respiratory infections 6

• Inappropriate dosing - Avoid "small adult" dosing; use weight-based calculations 4

• Prescribing based on perceived parental expectations - Studies show parents often prefer to avoid antibiotics when appropriate 7

• Inadequate monitoring - Children may experience unique adverse effects requiring close follow-up 5

• Failing to adjust for age-related pharmacokinetic differences - Neonates and young infants have immature renal and hepatic function affecting drug metabolism 2, 4

By following these evidence-based recommendations and principles, clinicians can optimize treatment outcomes while minimizing adverse effects and antibiotic resistance in pediatric patients with acute illnesses.