What is the recommended dose of amoxicillin (amoxicillin) for children?

Recommended Amoxicillin Dosing for Children

The recommended dose of amoxicillin for children aged 3 months and older weighing less than 40 kg is 25-45 mg/kg/day divided every 12 hours or 20-40 mg/kg/day divided every 8 hours, with the specific dose depending on the severity and type of infection. 1

Dosing by Age and Weight

Infants Less Than 12 Weeks (3 Months)

• Maximum recommended dose: 30 mg/kg/day divided every 12 hours 1
• This lower dosing reflects incompletely developed renal function affecting amoxicillin elimination

Children 3 Months and Older, Weighing Less Than 40 kg

For mild to moderate infections (ear/nose/throat, skin/skin structure, genitourinary tract):

• 25 mg/kg/day divided every 12 hours OR
• 20 mg/kg/day divided every 8 hours 1

For severe infections and lower respiratory tract infections:

• 45 mg/kg/day divided every 12 hours OR
• 40 mg/kg/day divided every 8 hours 1

Children Weighing 40 kg or More

• Use adult dosing: 250-500 mg every 8 hours or 500-875 mg every 12 hours, depending on infection severity 1

Condition-Specific Dosing

Pneumonia

• Children <5 years: 90 mg/kg/day in 2 doses 2
• Children ≥5 years: 90 mg/kg/day in 2 doses (maximum 4 g/day) 2

Acute Otitis Media

• Higher dosing of 75-90 mg/kg/day may be recommended, particularly in areas with high prevalence of resistant Streptococcus pneumoniae 3

Duration of Treatment

• Minimum treatment duration: 48-72 hours beyond symptom resolution 1
• For Streptococcus pyogenes infections: minimum 10 days to prevent acute rheumatic fever 1

Dosing in Renal Impairment

For children with severe renal impairment (GFR <30 mL/min):

• Dosage adjustment required
• GFR 10-30 mL/min: 250-500 mg every 12 hours
• GFR <10 mL/min: 250-500 mg every 24 hours 1

Administration Guidelines

• Administer at the start of a meal to minimize gastrointestinal intolerance 1
• For oral suspension, shake well before using
• Reconstituted suspension must be discarded after 14 days 1

Important Considerations

• Higher doses (70-90 mg/kg/day) are increasingly recommended for areas with high prevalence of penicillin-resistant pneumococci 2, 3
• When prescribing, include on the prescription: daily dose, number of divided doses, duration of therapy, indication, and child's weight 4
• Viral co-infection may reduce antibiotic efficacy, potentially requiring higher dosing 3

Common Pitfalls to Avoid

1. Using age-based rather than weight-based dosing, which can lead to under or overdosing 4
2. Inadequate dosing for resistant organisms, particularly in areas with high prevalence of resistant S. pneumoniae
3. Insufficient treatment duration, especially for streptococcal infections
4. Not adjusting doses for renal impairment in applicable patients

Following these evidence-based dosing recommendations ensures optimal therapeutic outcomes while minimizing the risk of treatment failure and antimicrobial resistance.