Amoxicillin 250mg/5ml Dosing for Typical Bacterial Infections
For pediatric patients with typical bacterial infections, amoxicillin 250mg/5ml suspension should be dosed at 40-45 mg/kg/day divided into two or three doses for mild infections, or 80-90 mg/kg/day divided into two or three doses for moderate-to-severe infections or when resistant pathogens are suspected. 1
Standard Pediatric Dosing by Severity
Mild to Moderate Infections
- 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours for ear/nose/throat, skin/skin structure, and genitourinary tract infections 1
- This translates to approximately 2.5 mL (125mg) per kg per day of the 250mg/5ml suspension, divided appropriately 1
Moderate to Severe Infections
- 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours for lower respiratory tract infections and severe ear/nose/throat infections 1
- This equals approximately 4.5 mL (225mg) per kg per day of the 250mg/5ml suspension 1
High-Dose Regimen for Resistant Pathogens
- 90 mg/kg/day divided every 12 hours (maximum 4000 mg/day) for suspected drug-resistant Streptococcus pneumoniae or recent antibiotic exposure 2
- This is 9 mL (450mg) per kg per day of the 250mg/5ml suspension, given in two divided doses 2
Age-Specific Considerations
Infants Under 3 Months
- Maximum 30 mg/kg/day divided every 12 hours due to immature renal function 1
- A twice-daily regimen of 50 mg/kg/day is superior to more frequent dosing in the first week of life 3
Children 3 Months and Older
- Follow weight-based dosing as outlined above, with maximum daily dose of 4000 mg 1
- For children weighing ≥40 kg, use adult dosing of 500mg every 12 hours or 250mg every 8 hours for mild infections 1
Infection-Specific Dosing
Streptococcal Pharyngitis
- 50 mg/kg once daily (maximum 1000 mg) OR 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 2
- This is critical to prevent acute rheumatic fever 1
Uncomplicated Urinary Tract Infections
- 500 mg every 8 hours for adults, with pediatric dosing at 40-45 mg/kg/day divided appropriately 2
- Duration: 3-7 days 2
Acute Otitis Media
- 75-90 mg/kg/day is recommended over the traditional 40 mg/kg/day, particularly with viral coinfection or resistant pathogens 4
- The higher dose achieves better middle ear fluid penetration and bacterial eradication 4, 5
Critical Dosing Pitfalls
Common errors to avoid:
- Do NOT substitute two 250mg doses for one 500mg dose when using combination products, as this results in excessive clavulanate 6
- Twice-daily dosing (every 12 hours) is preferable to three-times-daily for compliance and similar efficacy 7, 3
- Always continue treatment for minimum 48-72 hours beyond symptom resolution 1
- For Streptococcus pyogenes infections, minimum 10 days of therapy is mandatory to prevent rheumatic fever 1
Administration Guidelines
- Give at the start of meals to minimize gastrointestinal intolerance 1
- Shake suspension well before each use 1
- Reconstituted suspension remains stable for 14 days (refrigeration preferred but not required) 1
- Can be mixed with formula, milk, fruit juice, or water if needed, but must be taken immediately after mixing 1
Renal Impairment Adjustments
For patients with severe renal impairment (GFR <30 mL/min):