What are the recommended liquid antibiotics and dosages for a respiratory infection?

Recommended Liquid Antibiotics for Respiratory Infections

For respiratory infections in both adults and children, amoxicillin is the preferred first-line liquid antibiotic, with specific dosages based on age, weight, and infection severity. 1, 2

Pediatric Dosing Recommendations

Children ≥ 3 months and < 40 kg

• For mild/moderate upper respiratory infections (ear/nose/throat):

  • Amoxicillin: 20-25 mg/kg/day divided every 8-12 hours 2, 1

• For severe upper respiratory infections or any lower respiratory tract infection:

  • Amoxicillin: 40-45 mg/kg/day divided every 8-12 hours 2, 1
  • Amoxicillin-clavulanate: 80-90 mg/kg/day of amoxicillin component in three doses (not exceeding 3 g/day) 2

• For suspected resistant pathogens or treatment failure:

  • High-dose amoxicillin-clavulanate: 90 mg/6.4 mg per kg/day divided twice daily 2
  • Cefpodoxime-proxetil: 8 mg/kg/day in two doses 2

Children < 3 months

• For respiratory infections:
  • Amoxicillin: maximum 30 mg/kg/day divided every 12 hours (due to incompletely developed renal function) 1

Adult Dosing Recommendations

• For mild/moderate upper respiratory infections:

  • Amoxicillin: 500 mg every 12 hours or 250 mg every 8 hours 1

• For severe upper respiratory infections or lower respiratory tract infections:

  • Amoxicillin: 875 mg every 12 hours or 500 mg every 8 hours 1
  • Amoxicillin-clavulanate: 1.75-4 g/250 mg per day divided twice or three times daily 2

• For suspected resistant pathogens or treatment failure:

  • Respiratory fluoroquinolones (levofloxacin, moxifloxacin) - should be reserved for treatment failures or high-risk situations 2

Treatment Duration

• Standard duration: 7-10 days for most respiratory infections 2
• Shorter course options:
  • Cefuroxime-axetil and cefpodoxime-proxetil have shown efficacy with 5-day courses 2
  • Three-day amoxicillin treatment has been shown to be as effective as five-day treatment for non-severe pneumonia in children 3
• Minimum treatment duration: Continue for at least 48-72 hours beyond symptom resolution 1
• For Streptococcal infections: Minimum 10 days to prevent acute rheumatic fever 1

Special Considerations

Pathogen-Specific Recommendations

• For Mycoplasma pneumoniae:

  • Azithromycin: 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 2
  • Alternatives: clarithromycin (15 mg/kg/day in 2 doses) or erythromycin (40 mg/kg/day in 4 doses) 2

• For Haemophilus influenzae:

  • Amoxicillin-clavulanate (if β-lactamase producing) 2
  • Alternatives: cefdinir, cefixime, cefpodoxime, or ceftibuten 2

Administration Tips

• To minimize gastrointestinal intolerance: Take amoxicillin at the start of a meal 1
• For liquid suspension: Shake well before using; can be mixed with formula, milk, fruit juice, water, or cold drinks 1
• Storage: Refrigeration of reconstituted suspension is preferable but not required; discard unused portion after 14 days 1

Dosing in Renal Impairment

• Patients with GFR < 30 mL/min should NOT receive 875 mg amoxicillin doses 1
• For severe renal impairment (GFR 10-30 mL/min): 500 mg or 250 mg every 12 hours 1
• For very severe renal impairment (GFR < 10 mL/min): 500 mg or 250 mg every 24 hours 1

Antibiotic Stewardship Considerations

• Limit antibiotic exposure whenever possible to minimize selection for resistance 2
• Use the narrowest spectrum antibiotic required to treat the identified pathogen 2
• Higher doses of amoxicillin (75-90 mg/kg/day) may be needed in areas with high prevalence of resistant pneumococci or during viral co-infection 4
• Twice-daily dosing of amoxicillin has shown comparable efficacy to three-times-daily dosing, which may improve adherence 5, 6