What is the recommended dose of amoxicillin (amoxicillin) for a 2-year-old child with streptococcal pharyngitis (strep throat)?

Amoxicillin Dosing for Strep Throat in a 2-Year-Old Child

The recommended dose of amoxicillin for a 2-year-old child with streptococcal pharyngitis is 50 mg/kg once daily (maximum 1,000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for a full 10-day course. 1

Dosing Options

• For a 2-year-old child with strep throat, amoxicillin can be administered as:

  • 50 mg/kg once daily for 10 days (preferred for better adherence) 1
  • 25 mg/kg twice daily for 10 days (alternative regimen) 1
  • 40-45 mg/kg/day divided into 2-3 doses for 10 days (alternative dosing range) 2, 3

• The full 10-day course must be completed even if symptoms resolve earlier to prevent acute rheumatic fever 4, 1, 3

Administration Guidelines

• Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 3
• For oral suspension, shake well before using and refrigeration is preferable but not required 3
• The child is generally considered non-contagious after 24 hours of antibiotic therapy 4, 1

Clinical Considerations

• Amoxicillin is preferred over penicillin V for children due to:

  • Better palatability of the suspension 4
  • Once-daily dosing option that enhances adherence 1
  • Effectiveness against Group A Streptococcus 5
  • Narrow antimicrobial spectrum with few adverse effects 1, 2

• Clinical improvement should be expected within 24-48 hours of starting treatment 2

Alternative Options for Penicillin-Allergic Patients

• For children with non-immediate penicillin allergy, alternatives include:
  • Cephalexin: 20 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1, 2
  • Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1, 2
  • Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days (note: macrolide resistance is a concern) 1, 2

Evidence on Efficacy

• Research has shown that amoxicillin administered once daily at 40-50 mg/kg is as effective in eradicating Group A Streptococcus as multiple daily dosing regimens 5
• Studies demonstrate that amoxicillin at 40 mg/kg/day has better clinical and bacteriological cure rates compared to conventional penicillin V therapy 6

Treatment Failure Considerations

• If no improvement is seen within 48-72 hours, reassessment is necessary 2
• For recurrent or treatment-resistant cases, options include amoxicillin-clavulanate at 40 mg/kg/day of the amoxicillin component in three divided doses 2