Pediatric Amoxicillin Dosing Guidelines
The recommended pediatric oral dose of amoxicillin is 25-45 mg/kg/day divided every 12 hours for mild to moderate infections, and 45-90 mg/kg/day divided every 12 hours for severe infections, with treatment typically continuing for 7-10 days. 1, 2
Standard Dosing by Indication
Mild to Moderate Ear/Nose/Throat, Skin/Skin Structure, and Genitourinary Tract Infections:
- 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 1
Severe Ear/Nose/Throat, Skin/Skin Structure, and Genitourinary Tract Infections:
- 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1
Lower Respiratory Tract Infections (Mild/Moderate or Severe):
- 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1
Acute Otitis Media:
Group A Streptococcal Infections:
- 50-75 mg/kg/day in 2 doses 4
Special Populations
Infants Less Than 12 Weeks (3 Months):
- Maximum dose of 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 1
Children with Renal Impairment:
- No dose adjustment needed unless impairment is severe (GFR <30 mL/min) 1
Duration of Therapy
- Treatment should continue for a minimum of 48-72 hours beyond the time that the patient becomes asymptomatic 1
- For Streptococcus pyogenes infections, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 1
- For respiratory infections, treatment typically lasts 7-10 days 4
Dosing Frequency
- Twice-daily dosing is as effective as three-times-daily dosing for treating acute otitis media, which may improve medication compliance 5, 6
High-Dose vs. Standard-Dose Considerations
- High-dose amoxicillin (80-90 mg/kg/day) is recommended for areas with high pneumococcal resistance 2, 3
- Standard-dose amoxicillin (40-45 mg/kg/day) may be appropriate for children at low risk for infection with antibiotic-resistant bacteria 7
- For acute otitis media, high-dose amoxicillin is recommended due to concerns about resistant pneumococci 2, 3
Administration Guidelines
- Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 1
- For oral suspension, shake well before using and refrigeration is preferable but not required 1
- Any unused portion of reconstituted suspension must be discarded after 14 days 1
Common Adverse Effects
- Gastrointestinal disturbances (diarrhea, nausea, vomiting) 4
- Rash, urticaria, and other hypersensitivity reactions 4
Clinical Pearls
- Amoxicillin/clavulanate may be considered for recurrent or persistent infections where beta-lactamase-producing organisms are suspected 8
- The conventional pediatric dose of 40 mg/kg/day in three divided doses may be inadequate to effectively eradicate resistant Streptococcus pneumoniae, particularly during viral coinfection 3