What is the recommended dose of amoxicillin (amoxicillin) for a 1-year-old toddler weighing 11kg with a 1-week cough and no pneumonia?

Amoxicillin Dosing for a 1-Year-Old with Cough

Recommended Dosing

For a 1-year-old toddler weighing 11kg with a 1-week cough and no pneumonia, the recommended dose of amoxicillin is 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours. 1

This dosing recommendation is based on the FDA-approved dosing guidelines for mild to moderate ear/nose/throat and skin/skin structure infections, which is appropriate for a child with a cough but no pneumonia.

Dosing Calculation

For this 11kg child:

• If using twice-daily dosing: 25 mg/kg/day = 275 mg/day = 137.5 mg every 12 hours
• If using three-times-daily dosing: 20 mg/kg/day = 220 mg/day = 73.3 mg every 8 hours

Administration Guidelines

• Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 1
• For oral suspension, shake well before using
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 1

Treatment Duration Considerations

• For most respiratory infections, a 5-7 day course is typically sufficient
• The American Academy of Pediatrics suggests that shorter courses of antibiotic therapy (3-5 days) may be as effective as longer courses for certain infections, reducing the risk of adverse effects and antimicrobial resistance 2
• If the infection is caused by Streptococcus pyogenes, treatment should continue for at least 10 days to prevent acute rheumatic fever 1

Clinical Monitoring

• Assess clinical response within 48-72 hours of treatment initiation
• Look for decreased fever, improved respiratory rate, and decreased work of breathing as signs of improvement 2
• If no improvement after 48 hours, consider alternative diagnoses or treatments

Important Considerations

• The standard dose (25 mg/kg/day or 20 mg/kg/day) is appropriate for this case since pneumonia is not present
• Higher doses (45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours) would be indicated if pneumonia were present 2, 1
• Research has shown that twice-daily dosing is as effective as three-times-daily dosing with the same total daily dose, which may improve adherence 3

Potential Adverse Effects

• Common side effects include diarrhea, rash, and vomiting
• The frequency of adverse events is similar between twice-daily and three-times-daily dosing regimens (approximately 6.5%) 3

Antibiotic Stewardship

• Use the narrowest spectrum antibiotic effective for the presumed pathogen
• Avoid unnecessary broad-spectrum antibiotics when narrow-spectrum options are effective 2
• Use the shortest effective duration of therapy to reduce the risk of antimicrobial resistance 2