What is the recommended dose of amoxicillin (amoxicillin) liquid for a 24.45kg child with an upper respiratory infection and red sinuses?

Amoxicillin Dosing for Upper Respiratory Infection with Sinusitis in a 24.45kg Child

For a 24.45kg child with upper respiratory infection and red sinuses, the recommended dose of amoxicillin is 45-90 mg/kg/day divided into two doses, which equals approximately 550-1100 mg twice daily for 5-7 days. 1, 2

Dosing Algorithm

First-line Treatment:

1. Standard-dose amoxicillin: 45 mg/kg/day in 2 divided doses

   • For 24.45kg child = approximately 550 mg twice daily
   • Appropriate for mild-moderate infection in a child who hasn't received antibiotics in the past 4 weeks and doesn't attend childcare 1

2. High-dose amoxicillin: 80-90 mg/kg/day in 2 divided doses

   • For 24.45kg child = approximately 980-1100 mg twice daily
   • Recommended if:
     • Child is under 2 years
     • Child attends childcare
     • Recent antibiotic use (within 4 weeks)
     • Community has high prevalence (>10%) of non-susceptible S. pneumoniae 1

Alternative Treatment (if beta-lactamase producing organisms are suspected):

• Amoxicillin-clavulanate: 80-90 mg/kg/day of amoxicillin component in 2 divided doses 1, 3
  • For 24.45kg child = approximately 980-1100 mg of amoxicillin component twice daily

Administration Guidelines

• Give at the start of a meal to minimize gastrointestinal intolerance 2
• Shake oral suspension well before using 2
• Treatment should continue for 5-7 days for children over 2 years; younger children may require 10 days 3

Clinical Considerations

Pathogens Covered:

• Amoxicillin effectively treats Streptococcus pneumoniae, the most common bacterial cause of sinusitis 1, 4
• If beta-lactamase producing organisms (H. influenzae, M. catarrhalis) are suspected, amoxicillin-clavulanate should be used instead 4, 5

Treatment Duration:

• 5-7 days for uncomplicated cases in children over 2 years 3
• 10 days for children under 2 years 3

Monitoring:

• Assess clinical response after 48-72 hours 1
• If no improvement after 72 hours, consider:
  1. Switching to amoxicillin-clavulanate
  2. Adding a macrolide if atypical bacteria are suspected
  3. Referral if symptoms worsen 1, 3

Important Caveats

1. Weight-based dosing is critical: Estimating a child's weight can lead to significant under or overdosing. Always use actual measured weight for accurate dosing 6

2. Avoid macrolides as first-line therapy: Azithromycin and other macrolides have high rates of resistance among S. pneumoniae and should not be used as first-line therapy 1, 3

3. Consider watchful waiting: If symptoms are mild and the child is over 2 years, consider watchful waiting for 48-72 hours before starting antibiotics 3

4. Pain management: Ensure appropriate pain management regardless of antibiotic choice, especially during the first 24 hours 3

By following these evidence-based recommendations, you can provide effective treatment for this child's upper respiratory infection with sinusitis while minimizing the risk of antibiotic resistance and adverse effects.