What are the dosing guidelines for Amoxicillin (amoxicillin)

From the Guidelines

Amoxicillin dosing guidelines vary based on patient age, weight, infection type, and severity, with a recommended dose of 90 mg/kg/day in 2 doses for children with community-acquired pneumonia, as stated in the Pediatric Community Pneumonia Guidelines 1. The dosing guidelines for amoxicillin are as follows:

• For children with community-acquired pneumonia, the recommended dose is 90 mg/kg/day in 2 doses, with a maximum dose of 4 g/day 1.
• For children with otitis media, the recommended dose is 80-90 mg/kg/day divided twice daily 1.
• For adults with mild to moderate infections, the standard dose is 250-500 mg every 8 hours or 500-875 mg every 12 hours.
• Severe infections in adults may require up to 875 mg twice daily or 500 mg three times daily.
• Patients with renal impairment need dose adjustments, generally reducing the dose or extending the interval when creatinine clearance falls below 30 ml/min. Some key points to consider when prescribing amoxicillin include:
• The medication works by inhibiting bacterial cell wall synthesis, making it effective against many gram-positive and some gram-negative bacteria.
• Patients should complete the full course even if symptoms improve to prevent antibiotic resistance and ensure complete eradication of the infection.
• Amoxicillin should be taken with or without food, though taking with food may reduce gastrointestinal side effects.
• Treatment duration typically ranges from 5-14 days depending on the infection, with most common infections requiring 7-10 days. It's also important to note that amoxicillin dosing may vary based on local susceptibility data, and twice daily dosing of amoxicillin or amoxicillin clavulanate may be effective for pneumococci that are susceptible to penicillin, as mentioned in the guidelines 1.

From the FDA Drug Label

1. 2 Dosage for Adults and Pediatric Patients Aged 3 Months (12 weeks) and Older 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. In some infections, therapy may be required for several weeks. 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 Lower Respiratory Tract Mild/ Moderate or 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 dosing guidelines for Amoxicillin are as follows:

• Adults and Pediatric Patients Aged 3 Months and Older:
  • Ear/Nose/Throat:
    • Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours
    • Severe: 875 mg every 12 hours or 500 mg every 8 hours
  • Lower Respiratory Tract:
    • Mild/Moderate or Severe: 875 mg every 12 hours or 500 mg every 8 hours
• Pediatric Patients Aged Less than 12 Weeks (3 months):
  • Due to incompletely developed renal function, the recommended upper dose is 30 mg/kg/day divided every 12 hours
• H. pylori Infection in Adults:
  • Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily for 14 days
  • Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily for 14 days
• Renal Impairment:
  • Patients with impaired renal function do not generally require a reduction in dose unless the impairment is severe
  • Patients with a glomerular filtration rate of less than 30 mL/min should not receive the 875 mg dose 2

From the Research

Dosing Guidelines for Amoxicillin

• The dosing guidelines for amoxicillin vary depending on the specific condition being treated and the patient's weight and age.
• For the treatment of streptococcal pharyngitis, a study found that once-daily amoxicillin (750 mg or 1000 mg) was not inferior to twice-daily amoxicillin (2 doses of 375 mg or 500 mg) for 10 days 3.
• For lower respiratory tract infections, a study found that amoxicillin/clavulanate given every 12 hours (875/125 mg) was as effective as dosing every 8 hours (500/125 mg) for 7-15 days 4.
• For acute bacterial maxillary sinusitis, a study found that amoxicillin and clavulanate given every 12 hours (875 mg amoxicillin and 125 mg clavulanate) was as effective and safe as administration every 8 hours (500 mg amoxicillin and 125 mg clavulanate) for 14 days 5.
• For clinically diagnosed acute bacterial sinusitis, a study found that high-dose amoxicillin/clavulanate (2000 mg of extended-release amoxicillin with 125 mg of immediate-release clavulanate twice a day) was not more effective than standard-dose amoxicillin/clavulanate (875/125 mg) after 3 days of treatment, but a revised protocol using 1750 mg of immediate-release amoxicillin twice a day showed a significant improvement in symptoms after 3 days 6.
• For complicated skin and skin structure infections, a study found that sequential intravenous/oral moxifloxacin was clinically comparable to intravenous/oral amoxicillin/clavulanate, with similar clinical success rates and adverse event rates 7.

Specific Dosing Recommendations

• For streptococcal pharyngitis: 750 mg or 1000 mg once daily for 10 days 3
• For lower respiratory tract infections: 875/125 mg every 12 hours for 7-15 days 4
• For acute bacterial maxillary sinusitis: 875 mg amoxicillin and 125 mg clavulanate every 12 hours for 14 days 5
• For clinically diagnosed acute bacterial sinusitis: 875/125 mg standard-dose amoxicillin/clavulanate or 1750 mg immediate-release amoxicillin twice a day for high-dose 6