What is the appropriate dosing of Amoxicillin (amoxicillin) for streptococcal pharyngitis in pediatric patients?

From the Guidelines

For strep throat in pediatric patients, amoxicillin is the first-line antibiotic treatment at a dose of 50 mg/kg once daily (maximum 1000 mg per day) for 10 days, as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• Alternatively, amoxicillin can be given as 25 mg/kg twice daily (maximum 500 mg per dose) 1.
• Weight-based dosing is essential for children to ensure adequate treatment.
• The full 10-day course should be completed even if symptoms resolve earlier to prevent complications like rheumatic fever.
• Amoxicillin is preferred over penicillin due to better taste and absorption, leading to improved compliance.

Management and Prevention

• For children with penicillin allergy, alternatives include cephalexin (if non-anaphylactic allergy), or macrolides like azithromycin (if severe allergy) 1.
• Parents should be advised to ensure the child stays well-hydrated, completes the full antibiotic course, and uses appropriate pain relief like acetaminophen or ibuprofen for symptom management.
• Children can typically return to school after 24 hours of antibiotic therapy when they are no longer contagious.

Evidence-Based Recommendations

• The Infectious Diseases Society of America recommends amoxicillin as a first-line treatment for streptococcal pharyngitis in pediatric patients 1.
• A Cochrane review and meta-analysis found that short-duration treatment with antibiotics like amoxicillin showed slightly better clinical outcomes, but the differences were small 1.
• The 2002 practice guidelines for the diagnosis and management of group A streptococcal pharyngitis also support the use of amoxicillin as an alternative to penicillin V 1.

From the FDA Drug Label

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 Table 1 ... Ear/Nose/Throat ... 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

The appropriate dosing of Amoxicillin for streptococcal pharyngitis in pediatric patients is:

• For patients 3 months or older and weighing less than 40 kg:
  • Mild/Moderate infections: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
  • Severe infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours
• 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, and for at least 10 days to prevent acute rheumatic fever 2

From the Research

Amoxicillin Dosing for Streptococcal Pharyngitis in Pediatric Patients

• The appropriate dosing of amoxicillin for streptococcal pharyngitis in pediatric patients is a topic of research, with various studies investigating different dosing regimens 3, 4.
• A study published in 2019 found that once-daily administration of amoxicillin may be effective in the treatment of group A streptococcal pharyngitis, with a dose of 40-50 mg/kg/day divided into one, two, or three daily doses for 10 days 3.
• Another study published in 2006 compared once-daily amoxicillin with conventional twice-daily amoxicillin therapy for group A streptococcal pharyngitis, and found that once-daily amoxicillin was not inferior to twice-daily amoxicillin 4.
• The dosing regimen for amoxicillin in pediatric patients with streptococcal pharyngitis is typically 40-50 mg/kg/day, divided into one, two, or three daily doses for 10 days 3, 4.
• It is worth noting that the American Academy of Pediatrics recommends a dose of 50 mg/kg/day of amoxicillin for the treatment of streptococcal pharyngitis in pediatric patients, although this is not explicitly stated in the provided studies 3, 4.

Comparison with Other Antibiotics

• Other antibiotics, such as clarithromycin and azithromycin, have also been studied for the treatment of streptococcal pharyngitis in pediatric patients 5, 6.
• A study published in 2004 compared the efficacy of clarithromycin, amoxicillin/clavulanate, and penicillin V for the treatment of group A streptococcal tonsillopharyngitis, and found that all regimens had similar clinical efficacy, but amoxicillin/clavulanate and penicillin V were more effective in eradicating the bacteria 6.
• Macrolides, such as clarithromycin and azithromycin, may be used as alternative treatments for patients allergic to penicillin, but their use may be limited by resistance patterns 5, 6.

Duration of Treatment

• The duration of treatment for streptococcal pharyngitis in pediatric patients is typically 10 days, although shorter courses of antibiotics may be effective in some cases 7.
• A study published in 2009 found that 3-6 days of oral antibiotics had comparable efficacy to the standard 10-day course of oral penicillin for the treatment of acute group A streptococcal pharyngitis in children 7.