What is the recommended dosage of amoxicillin (amoxicillin) for children in India?

Recommended Dosage of Amoxicillin for Children in India

For children in India, the recommended dosage of amoxicillin ranges from 45-90 mg/kg/day divided into 2-3 doses, with specific dosing based on the severity and type of infection being treated. 1

General Dosing Guidelines

• For mild to moderate infections: 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours 2
• For severe infections: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 2
• For respiratory tract infections (particularly pneumonia): 75-90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses 1

Age-Specific Considerations

• For infants less than 12 weeks (3 months): Maximum recommended dose is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2
• For children 3 months to 40 kg: Dose is calculated based on weight and infection severity 2
• For children weighing more than 40 kg: Adult dosing can be used 2

Infection-Specific Dosing

Respiratory Infections

• For community-acquired pneumonia:

  • Preferred dose: 90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses 1
  • Treatment duration: 5-7 days is typically sufficient for uncomplicated cases 3, 4

• For otitis media (ear infections):

  • Recommended dose: 75-100 mg/kg/day in 3 doses 1, 5
  • Higher doses (75-90 mg/kg/day) are recommended particularly when viral coinfection is suspected 5

• For Group A Streptococcal infections:

  • 50-75 mg/kg/day in 2 doses 1
  • Treatment should continue for at least 10 days to prevent acute rheumatic fever 2

Other Infections

• For skin/skin structure infections:

  • Mild/moderate: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
  • Severe: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2

• For urinary tract infections:

  • 40 mg/kg/day in 3 divided doses for 5 days 1

Administration Considerations

• Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 2
• Oral suspension should be shaken well before using 2
• For improved adherence in children, twice-daily dosing (q12h) provides comparable efficacy to three-times-daily dosing for most infections 6, 7

Dosage Adjustments

• For children with renal impairment (GFR 10-30 mL/min): Reduce dose or extend interval based on severity 2
• For children with severe renal impairment (GFR <10 mL/min): 250-500 mg every 24 hours 2

Common Pitfalls and Caveats

• Underdosing amoxicillin is a common problem, particularly for respiratory infections where higher doses are needed to overcome resistant organisms 5
• Standard dosing of 40 mg/kg/day may be inadequate for treating otitis media, particularly with resistant Streptococcus pneumoniae 5
• Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 2
• For Streptococcal infections, completing the full 10-day course is critical to prevent complications, even if symptoms improve earlier 2

By following these evidence-based dosing recommendations, clinicians in India can optimize treatment outcomes while minimizing the risk of antimicrobial resistance and adverse effects in pediatric patients.