What is the appropriate dosing of amoxicillin (amoxicillin) for pneumonia in a pediatric patient, 3 years of age, weighing 14 kilograms?

From the Guidelines

For a 3-year-old child weighing 14kg with pneumonia, the recommended amoxicillin dosage is 90 mg/kg/day divided into two doses, which equals approximately 630 mg twice daily for a total of 1260 mg daily. The typical treatment duration is 5-7 days for community-acquired pneumonia 1. The medication can be given as a suspension, with common formulations being 250mg/5mL or 400mg/5mL. For the 250mg/5mL suspension, you would give 12.6mL twice daily, and for the 400mg/5mL suspension, you would give 7.9mL twice daily. Amoxicillin is effective against Streptococcus pneumoniae, the most common bacterial cause of pneumonia in children. It's essential to complete the full course of antibiotics even if the child feels better before it's finished. Watch for side effects such as diarrhea, rash, or signs of allergic reaction. If the child vomits within 30 minutes of taking a dose, you may need to repeat that dose. Ensure adequate hydration and rest during treatment. If symptoms worsen or don't improve after 48-72 hours, contact your healthcare provider.

Some key considerations for the treatment of pneumonia in children include:

• The choice of antibiotic should be based on the suspected or confirmed pathogen, as well as local resistance patterns 1.
• The dosage and duration of treatment should be adjusted according to the child's age, weight, and severity of illness.
• It's crucial to monitor the child's response to treatment and adjust the antibiotic regimen as needed.
• Parents or caregivers should be educated on the importance of completing the full course of antibiotics, even if the child feels better before the treatment is finished.

In terms of specific dosing recommendations, the guidelines suggest that amoxicillin can be given at a dose of 90 mg/kg/day in two divided doses for the treatment of community-acquired pneumonia in children 1. However, the dosage may need to be adjusted based on the child's renal function and other factors. It's always best to consult with a healthcare provider for personalized treatment recommendations.

From the FDA Drug Label

Infections of the Lower Respiratory Tract: Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus spp. (α-and β-hemolytic isolates only), S. pneumoniae, Staphylococcus spp., or H. influenzae.

Table 1 ... Lower Respiratory Tract Mild/ Moderate or Severe 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

For a pediatric patient, 3 years of age, weighing 14 kilograms, with pneumonia, the appropriate dosing of amoxicillin is:

• 45 mg/kg/day in divided doses every 12 hours or
• 40 mg/kg/day in divided doses every 8 hours For this patient, the dose would be:
• 14 kg x 45 mg/kg/day = 630 mg/day, divided into 2-3 doses, or
• 14 kg x 40 mg/kg/day = 560 mg/day, divided into 3 doses So the dose is approximately 315-315 mg every 12 hours or 187-220 mg every 8 hours 2

From the Research

Amoxicillin Dosing for Pediatric Pneumonia

• The appropriate dosing of amoxicillin for pneumonia in a pediatric patient, 3 years of age, weighing 14 kilograms, can be determined based on the available evidence.
• A study published in 2021 3 found that a lower dose of amoxicillin (35-50 mg/kg/d) was noninferior to a higher dose (70-90 mg/kg/d) in children with community-acquired pneumonia.
• Another study published in 2021 4 compared the efficacy and safety of amoxicillin at a lower dose (35-50 mg/kg/day) and a higher dose (70-90 mg/kg/day) in children with uncomplicated community-acquired pneumonia, and found that the lower dose was noninferior to the higher dose.
• Based on these studies, a dose of 35-50 mg/kg/d of amoxicillin can be considered appropriate for a 3-year-old child weighing 14 kilograms, which would be approximately 490-700 mg per day.
• The duration of treatment is also an important consideration, with studies suggesting that 3-day treatment is noninferior to 7-day treatment in children with community-acquired pneumonia 4, 3.
• However, it is essential to note that the specific dosing and duration of treatment should be determined by a healthcare professional based on the individual child's needs and medical history.

Considerations for Amoxicillin Dosing

• The dosing of amoxicillin may vary depending on the severity of the pneumonia and the presence of other underlying medical conditions.
• A study published in 2003 5 found that high-dose amoxicillin/clavulanic acid (90/6.4 mg/kg/day) was effective in treating acute otitis media in children, but this dose may not be necessary for all cases of pneumonia.
• Another study published in 2002 6 compared the efficacy of 3-day and 5-day courses of amoxicillin in children with non-severe pneumonia and found that the 3-day course was equally effective as the 5-day course.
• A study published in 2003 7 compared the pharmacokinetics of amoxicillin given twice or three times per day to children with pneumonia and found that the twice-daily regimen was a feasible alternative to the three-times-daily regimen.