What is the maximum daily dose of amoxicillin (amoxicillin) for pediatric patients?

Maximum Daily Dose of Amoxicillin for Pediatric Patients

The maximum daily dose of amoxicillin for pediatric patients is 90 mg/kg/day with a maximum of 4000 mg/day (4 g/day). 1

Dosing Guidelines by Weight and Age

For Children Weighing Less Than 40 kg

• For mild to moderate infections (ear/nose/throat, skin/skin structure, genitourinary tract):

  • 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 2

• For severe infections (including lower respiratory tract infections):

  • 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
  • For community-acquired pneumonia: 90 mg/kg/day in 2 doses 1

For Children Weighing 40 kg or More

• For mild to moderate infections:

  • 500 mg every 12 hours or 250 mg every 8 hours 2

• For severe infections:

  • 875 mg every 12 hours or 500 mg every 8 hours 2
  • Maximum daily dose: 4000 mg/day (e.g., one 2000-mg tablet twice daily) 1

Special Considerations

For Children Less Than 12 Weeks (3 Months) Old

• Due to incompletely developed renal function, the maximum recommended dose is 30 mg/kg/day divided every 12 hours 2

For Patients with Renal Impairment

• Patients with GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity 2
• Patients with GFR less than 10 mL/min: 500 mg or 250 mg every 24 hours, depending on infection severity 2

Clinical Pearls and Pitfalls

• When prescribing amoxicillin for community-acquired pneumonia in children, the recommended dose is 90 mg/kg/day in 2 doses with a maximum of 4000 mg/day 1
• For older children and those in higher weight categories, physicians often prescribe lower-than-recommended doses, which may lead to treatment failure 3
• The impact of childhood obesity on high-dose amoxicillin recommendations has not been adequately addressed in guidelines 3
• Dosing should be based on body weight rather than age to ensure appropriate dosing, especially in children with weights that deviate from typical growth curves 4

Dosing Frequency Considerations

• While traditional dosing has been three times daily, evidence suggests that twice-daily dosing (with appropriate dose adjustment) may provide comparable efficacy while improving adherence 5, 6
• For community-acquired pneumonia, the recommended regimen is 90 mg/kg/day in 2 doses 1

Remember that appropriate dosing of amoxicillin is essential for treatment success while minimizing the risk of adverse effects and antimicrobial resistance.