Amoxicillin Dosing for Pneumonia in an 11-Year-Old Weighing 94 Pounds
For an 11-year-old child weighing 94 pounds (approximately 42.6 kg) with pneumonia, the recommended dose of amoxicillin is 90 mg/kg/day divided into two doses, which equals approximately 1900 mg twice daily for a total daily dose of 3800 mg. 1
Dosing Calculation and Rationale
The most recent guidelines from the American Academy of Pediatrics recommend amoxicillin as the first-line empiric antibiotic treatment for children with pneumonia, with specific dosing recommendations:
- For children ≥5 years: Amoxicillin 90 mg/kg/day in 2 divided doses, with a maximum of 4 g/day 1
- For this 11-year-old weighing 42.6 kg:
- 90 mg/kg/day = 3834 mg/day (rounded to 3800 mg/day)
- Divided into two doses = 1900 mg twice daily
This high-dose amoxicillin regimen is specifically recommended to ensure adequate coverage against Streptococcus pneumoniae, including strains with reduced susceptibility to penicillin 1, 2.
Duration of Treatment
The optimal duration of treatment for community-acquired pneumonia in children is 5-7 days 1, 3:
- Recent evidence suggests that a 5-day course of amoxicillin is as effective as a 10-day course for uncomplicated community-acquired pneumonia in children 3
- The American College of Physicians recommends limiting treatment duration to 5-7 days for most common infections to reduce antimicrobial resistance while maintaining efficacy 1
Alternative Options
If the child has a penicillin allergy or if atypical pathogens are suspected, alternative options include:
Macrolides (for atypical pathogens):
For penicillin allergy:
- Cefpodoxime, cefuroxime, or cefprozil 1
Monitoring and Follow-up
- Reassess the child after 48-72 hours of antibiotic therapy 1
- Consider hospitalization if there is:
- Severe respiratory distress
- Inability to maintain oral hydration
- Oxygen saturation <92%
- Toxic appearance
- Failure to respond to outpatient management 1
Important Considerations
- The British Thoracic Society guidelines (2002) suggest lower doses for amoxicillin, but these are outdated compared to more recent recommendations 4
- Higher doses (90 mg/kg/day) are now preferred due to increasing prevalence of pneumococcal strains with reduced penicillin susceptibility 1, 2
- Common errors to avoid include inadequate dosing of amoxicillin and failure to reassess after 48-72 hours if no clinical improvement 1
This high-dose amoxicillin regimen has been shown to be effective in multiple studies, with low rates of treatment failure and good safety profiles 5, 6, 7.