What is the appropriate dose and duration of amoxicillin (amoxicillin) oral suspension for a 6-year-old boy weighing 25.1 kilograms with a dental infection?

From the Guidelines

The appropriate dose of amoxicillin oral suspension for a 6-year-old boy weighing 25.1 kilograms with a dental infection is 40-50 mg/kg/day in divided doses every 8 hours, with a maximum dose of 500 mg every 8 hours, for a duration of 7-10 days 1.

Key Considerations

• The dose of amoxicillin for children is based on weight, with a recommended dose of 40-50 mg/kg/day in divided doses every 8 hours 1.
• The maximum dose of amoxicillin for children is 500 mg every 8 hours 1.
• The duration of treatment for a dental infection is typically 7-10 days.
• It is essential to note that the use of fluoroquinolones is contraindicated in children and adolescents < 18 years of age, and tetracyclines are rarely used in children < 8 years of age 1.

Treatment Guidelines

• For a dental infection, amoxicillin is the preferred choice for oral therapy because it is well absorbed in the GI tract and provides high and sustained serum concentrations 1.
• For individuals who are allergic to penicillins or amoxicillin, alternative antibiotics such as cephalexin, clindamycin, azithromycin, or clarithromycin may be used 1.
• Patients who are unable to tolerate an oral antibiotic may be treated with ampicillin, ceftriaxone, or cefazolin administered intramuscularly or intravenously 1.

From the FDA Drug Label

To minimize the potential for gastrointestinal intolerance, amoxicillin should be taken at the start of a meal. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Table 1 ... Ear/Nose/Throat ... Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe 875 mg every 12 hours or 500 mg every 8 hours 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

For a 6-year-old boy weighing 25.1 kilograms with a dental infection, the appropriate dose of amoxicillin oral suspension would be:

• For mild to moderate infections: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
• For severe infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours The duration of treatment should be at least 10 days to prevent the occurrence of acute rheumatic fever if the infection is caused by Streptococcus pyogenes, and should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 2.

From the Research

Amoxicillin Dosage and Duration for Dental Infection in Children

• The optimal dose and duration of amoxicillin for a 6-year-old boy weighing 25.1 kilograms with a dental infection is not directly addressed in the provided studies, as they focus on community-acquired pneumonia and group A streptococcal pharyngitis 3, 4, 5, 6, 7.
• However, a study on community-acquired pneumonia in children suggests that amoxicillin can be given at a dose of 35-50 mg/kg/day or 70-90 mg/kg/day for 3 or 7 days, with no significant difference in efficacy between the two doses and durations 4, 6.
• Another study on group A streptococcal pharyngitis found that once-daily administration of amoxicillin at a dose of 40-50 mg/kg/day was as effective as multiple-daily dosing regimens in eradicating the infection 7.
• A study comparing pharmacokinetics of amoxicillin given twice or three times per day to children with pneumonia suggests that a 30- to 40-mg/kg/dose twice daily may be a feasible alternative to thrice daily dosing 5.

Considerations for Dental Infections

• The American Academy of Pediatric Dentistry recommends amoxicillin as the first-line antibiotic for dental infections in children, with a dosage of 50 mg/kg/day divided into 3 doses per day for 5-7 days 3.
• However, the provided studies do not specifically address dental infections, and the dosage and duration of amoxicillin may vary depending on the severity and type of infection, as well as the child's weight and medical history.
• It is essential to consult with a pediatrician or dentist to determine the appropriate dose and duration of amoxicillin for a 6-year-old boy with a dental infection, taking into account the specific circumstances of the case 3, 4, 5, 6, 7.