What is the recommended dose of Amoxil (amoxicillin) for a 5-year-old girl with strep throat?

Amoxicillin Dosage for a 5-Year-Old Girl with Strep Throat

For a 5-year-old girl with strep throat, the recommended dose of amoxicillin is 50 mg/kg/day divided into two doses for 10 days. 1

Dosing Recommendations

• Amoxicillin is the first-line treatment for Group A Streptococcal (GAS) pharyngitis in children without penicillin allergy 1
• The specific dosing regimen for a 5-year-old with strep throat is:
  • 50 mg/kg/day divided into two doses (maximum 1,000 mg daily) 1
  • Alternative dosing: 25 mg/kg twice daily (maximum 500 mg per dose) 1
• Duration of treatment should be 10 days to prevent complications such as acute rheumatic fever 1, 2

Rationale for Amoxicillin as First-Line Therapy

• Amoxicillin is preferred due to its:
  • Narrow spectrum of activity against Group A Streptococcus 1
  • Excellent safety profile with few adverse effects 1
  • Cost-effectiveness compared to alternatives 1
  • Once or twice daily dosing improves compliance compared to penicillin V's three or four times daily dosing 3

Alternative Options for Penicillin-Allergic Patients

If the patient has a penicillin allergy, alternative treatments include:

• Cephalexin: 20 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1
• Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1
• Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1

Important Clinical Considerations

• Ensure completion of the full 10-day course even if symptoms improve within a few days to prevent complications and recurrence 2
• Administer amoxicillin at the start of a meal to minimize gastrointestinal intolerance 2
• Monitor for common side effects including diarrhea, nausea, and skin rash 1
• No follow-up post-treatment testing is routinely recommended unless symptoms persist 1

Common Pitfalls to Avoid

• Underdosing: Using standard "pneumonia" dosing (40 mg/kg/day) is inadequate for strep throat; ensure the full 50 mg/kg/day dose is prescribed 1, 4
• Incorrect duration: Shorter courses (less than 10 days) may lead to treatment failure and complications like rheumatic fever 2
• Inappropriate use of broad-spectrum antibiotics: Reserve broader spectrum antibiotics for patients with penicillin allergy or treatment failures 1
• Failure to shake suspension properly: Instruct caregivers to shake the oral suspension well before each use to ensure proper dosing 2

Special Situations

• For recurrent strep throat or treatment failures, consider:
  • Checking for proper medication adherence 1
  • Testing for beta-lactamase producing organisms 1
  • Evaluating for chronic carrier state 1
  • Consider alternative regimens such as amoxicillin-clavulanate if treatment failure occurs 1

By following these evidence-based recommendations, you can effectively treat strep throat in a 5-year-old girl while minimizing the risk of complications and antimicrobial resistance.