Amoxicillin Dosing for 9.4kg Child with Community-Acquired Pneumonia
For a 9.4kg male child with community-acquired pneumonia, administer amoxicillin 90 mg/kg/day divided into 2 doses, which equals 423 mg twice daily (approximately 8.5 mL of the 250mg/5mL suspension twice daily). 1
Dose Calculation
- Total daily dose: 90 mg/kg/day × 9.4 kg = 846 mg/day 1
- Per dose (twice daily): 846 mg ÷ 2 = 423 mg per dose 1
- Volume per dose: 423 mg ÷ 50 mg/mL = 8.5 mL twice daily 1
Dosing Rationale
The Pediatric Infectious Diseases Society and Infectious Diseases Society of America guidelines specifically recommend high-dose amoxicillin at 90 mg/kg/day divided into 2 doses for outpatient treatment of presumed bacterial community-acquired pneumonia in children under 5 years old. 1 This high-dose regimen is designed to overcome potential penicillin resistance in Streptococcus pneumoniae, which has become increasingly prevalent. 1
Treatment Duration
- Standard duration: 7 days for uncomplicated community-acquired pneumonia 1
- Recent evidence suggests that 3-day courses may be non-inferior to 7-day courses in children who show substantial improvement, though cough resolution may be slightly faster with 7 days (10 days vs 12 days). 2
Clinical Monitoring
Children should demonstrate clinical improvement within 48-72 hours of initiating therapy, including fever resolution and reduced respiratory symptoms. 1, 3 If the child deteriorates or shows no improvement within 48-72 hours, further investigation and potential treatment modification are necessary. 1
Important Caveats
- Age consideration: This child appears to be under 5 years old based on weight, placing them in the preschool category where bacterial pneumonia (particularly S. pneumoniae) is the primary concern. 1
- Atypical coverage: For children ≥5 years old with features that don't clearly distinguish bacterial from atypical pneumonia, consider adding a macrolide to the β-lactam regimen. 1 However, for this 9.4kg child (likely under 5 years), amoxicillin monotherapy is appropriate. 1
- Alternative formulation: If using amoxicillin-clavulanate instead, the amoxicillin component should still be 90 mg/kg/day in 2 doses. 1