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

Recommended Amoxicillin Dosing for Pediatric Patients

For pediatric patients, the recommended dose of amoxicillin is 45 mg/kg/day divided into two doses for mild to moderate infections, and 90 mg/kg/day divided into two doses for severe infections or in areas with high pneumococcal resistance. 1

Dosing Based on Age and Weight

• For infants less than 12 weeks (3 months) of age: The maximum recommended dose is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2
• For children 3 months and older weighing less than 40 kg:
  • Mild/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 2
  • 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 2
  • 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 2

Dosing Based on Specific Indications

• For respiratory tract infections such as pneumonia: 45 mg/kg/day in 2 doses for mild to moderate infections 1
• For severe respiratory infections or areas with high pneumococcal resistance: 90 mg/kg/day in 2 doses 1
• For Group A Streptococcal infections: 50-75 mg/kg/day in 2 doses 1
• For acute otitis media, especially with resistant pathogens: 75-90 mg/kg/day is recommended 3

Administration Guidelines

• To minimize gastrointestinal intolerance, amoxicillin should be taken at the start of a meal 2
• Treatment should continue for a minimum of 48 to 72 hours beyond symptom resolution 2
• For Streptococcus pyogenes infections, a minimum of 10 days treatment is recommended to prevent acute rheumatic fever 2

Dosing in Special Populations

• For patients with renal impairment:
  • GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity 2
  • GFR less than 10 mL/min: 500 mg or 250 mg every 24 hours, depending on infection severity 2
  • Hemodialysis patients: 500 mg or 250 mg every 24 hours with additional doses during and at the end of dialysis 2

Important Clinical Considerations

• The current conventional dosing of 40 mg/kg/day in three divided doses may be inadequate for resistant Streptococcus pneumoniae, particularly during viral coinfection 3
• Studies have shown that twice-daily dosing regimens are as effective as three-times-daily regimens when using the same total daily dose 4
• For children with higher body weight, there is debate about whether to cap the dose at the standard adult maximum (1500 mg/day) or continue with weight-based dosing 5
• Children on appropriate antibiotic therapy should show clinical improvement within 48-72 hours; if not, reevaluation is necessary 1

Preparation of Oral Suspension

• After reconstitution, the oral suspension should be shaken well before using 2
• Any unused portion must be discarded after 14 days 2
• Refrigeration is preferable but not required 2

Remember that weight-based dosing is preferred over age-based dosing to ensure appropriate antibiotic concentrations 6.