From the Guidelines
The maximum dose of amoxicillin for a pediatric patient is 90 mg/kg/day divided into two or three doses, with an absolute maximum of 4000 mg (4 grams) per day regardless of weight. This dosage recommendation is based on guidelines for the management of community-acquired pneumonia in infants and children older than 3 months of age, as outlined in the Clinical Infectious Diseases journal 1. For most common infections like otitis media or streptococcal pharyngitis, the standard dose is 40-50 mg/kg/day divided into two or three doses. Higher doses (80-90 mg/kg/day) are recommended for more severe infections such as pneumonia or sinusitis, particularly in areas with drug-resistant Streptococcus pneumoniae.
- Key considerations for amoxicillin dosing in pediatric patients include:
- Calculating the dose based on the child's weight rather than age
- Using an appropriate measuring device like a medication syringe for liquid formulations
- The duration of treatment typically ranges from 5-10 days depending on the infection being treated
- Amoxicillin works by inhibiting bacterial cell wall synthesis, and the higher dosing for certain infections helps overcome partially resistant organisms by achieving higher drug concentrations at the infection site It's essential to follow these guidelines and consider the specific infection being treated, as well as local susceptibility data, to ensure effective treatment and minimize the risk of resistance 1.
From the FDA Drug Label
Table 1 ... Ear/Nose/Throat Skin/Skin Structure Genitourinary Tract Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe 875 mg every 12 hours or 500 mg every 8 hours 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours ... 2.3 Dosage in Pediatric Patients Aged Less than 12 Weeks (3 months) ... Due to incompletely developed renal function affecting elimination of amoxicillin in this age group, the recommended upper dose of amoxicillin is 30 mg/kg/day divided every 12 hours.
The maximum dose of amoxicillin for a pediatric patient is 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for patients aged 3 months and older and weight less than 40 kg, and 30 mg/kg/day divided every 12 hours for patients aged less than 12 weeks 2.
From the Research
Maximum Dose of Amoxicillin for Pediatric Patients
- The American Academy of Pediatrics recommends a high-dose amoxicillin regimen of 80 to 90 mg/kg per day for the treatment of acute uncomplicated otitis media 3.
- However, if a patient's estimated amoxicillin dose exceeds the standard adult dose (1500 mg/d), some clinicians may prescribe the standard adult dose instead of the recommended dose of 80 to 90 mg/kg per day 3.
- There is no specific mention of a maximum dose of amoxicillin for pediatric patients in the other studies 4, 5, 6, 7.
- It is essential to note that the dosage of amoxicillin may vary depending on the specific condition being treated, such as group A streptococcal pharyngitis, and the patient's weight and age 6, 7.
Considerations for Amoxicillin Dosage
- The dosage of amoxicillin should be based on the patient's weight, with children weighing 20 kg or less receiving higher mean daily doses 3.
- Clinicians should be aware of the potential for antibiotic resistance and the importance of antimicrobial stewardship when prescribing amoxicillin 5.
- The use of amoxicillin in pediatric patients should be guided by evidence-based guidelines and clinical judgment, taking into account the specific condition being treated and the patient's individual needs 6, 7.