What is the appropriate dose of amoxicillin (amoxicillin) for an 11-year-old child weighing 94 kg with pneumonia?

Amoxicillin Dosing for an 11-Year-Old Child Weighing 94 kg with Pneumonia

For an 11-year-old child weighing 94 kg with pneumonia, the appropriate dose of amoxicillin is 90 mg/kg/day divided into two doses (maximum 4 g/day), which would be 2000 mg twice daily for this patient. 1

Dosing Rationale

The dosing recommendation for this patient is based on several key considerations:

1. Weight-based dosing with maximum limits:

   • For children with pneumonia, amoxicillin should be dosed at 90 mg/kg/day in 2 divided doses 1
   • For a 94 kg child, this would calculate to 8,460 mg/day (94 kg × 90 mg/kg)
   • However, this exceeds the maximum daily dose of 4 g/day 1
   • Therefore, the appropriate dose is capped at 4 g/day, or 2000 mg twice daily

2. Age-appropriate considerations:

   • For children ≥5 years with pneumonia, high-dose amoxicillin is recommended 1
   • At 11 years old, this patient falls into this category, requiring the higher dosing range

Administration Guidelines

• Administer amoxicillin at the start of a meal to minimize gastrointestinal intolerance 2
• Treatment should be continued for a minimum of 5-7 days 1
• Reassess after 48-72 hours of therapy; if no improvement is seen, consider alternative antibiotics 1

Alternative Options

If the patient has a penicillin allergy or does not respond to initial therapy:

• For mild to moderate penicillin allergy: Consider a cephalosporin such as cefpodoxime, cefuroxime, or cefprozil 1
• For severe penicillin allergy: Consider a macrolide such as azithromycin, particularly if atypical pathogens are suspected 1
• For treatment failure: Consider amoxicillin-clavulanate as a second-line agent 3, 1

Important Clinical Considerations

• Dosing for obese children: This child's weight (94 kg) is significantly above average for an 11-year-old. While we're using actual body weight for the calculation, we're applying the maximum daily dose cap of 4 g/day to avoid excessive dosing 2

• Treatment duration: Recent evidence suggests that shorter courses (5 days) may be as effective as longer courses (7-10 days) for uncomplicated pneumonia 4, 5, but treatment should be continued for at least 48-72 hours beyond symptom resolution 2

• Monitoring: Assess for clinical improvement within 48-72 hours. Signs of improvement include decreased fever, improved respiratory rate, and decreased work of breathing 1

Common Pitfalls to Avoid

1. Underdosing: Using standard adult doses rather than weight-based dosing can lead to treatment failure in children with pneumonia

2. Inappropriate duration: Defaulting to 10-day courses regardless of clinical response may contribute to antimicrobial resistance 1

3. Failure to reassess: Not evaluating the patient's response after 48-72 hours of therapy can delay necessary changes in treatment 1

4. Ignoring maximum dose limits: While weight-based dosing is important, applying the maximum daily dose cap is essential for patient safety, especially in larger children 2

By following these guidelines, you can provide appropriate amoxicillin dosing for this 11-year-old patient with pneumonia while maximizing efficacy and minimizing risks.