From the Guidelines
The maximum dose of amoxicillin for pediatric patients is 90 mg/kg/day divided into two doses, with an absolute maximum of 4000 mg (4 grams) per day regardless of weight. This dosing recommendation is based on the most recent and highest quality study available, which provides guidelines for the management of community-acquired pneumonia in infants and children older than 3 months of age 1. For most common infections like otitis media or sinusitis, the standard high-dose regimen is 80-90 mg/kg/day divided twice daily.
- The dosing is based on the child's weight, and liquid formulations typically come as 125 mg/5mL, 200 mg/5mL, 250 mg/5mL, or 400 mg/5mL suspensions.
- It's essential to complete the full course of treatment (usually 7-10 days) even if symptoms improve earlier, as this helps to ensure that the infection is fully cleared and reduces the risk of resistance development.
- Amoxicillin works by inhibiting bacterial cell wall synthesis, and the higher dosing is often needed to overcome partially resistant pneumococci.
- Side effects may include diarrhea, rash, and rarely allergic reactions, and amoxicillin should be used cautiously in patients with penicillin allergy.
- Dose adjustments are necessary for patients with significant renal impairment, and alternative treatments may be considered for children with a history of possible, nonserious allergic reactions to amoxicillin 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 pediatric patients is:
- For patients aged 3 months and older and weight less than 40 kg: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours
- For patients aged less than 12 weeks (3 months): 30 mg/kg/day divided every 12 hours 2
From the Research
Amoxicillin Dosing for Pediatric Patients
- The maximum dose of amoxicillin for pediatric patients is not explicitly stated in the provided studies, but the recommended dose can be inferred from the available information.
- According to 3, the World Health Organization recommends higher dose amoxicillin given twice daily for five days for all uncomplicated respiratory infections where an antibiotic is indicated.
- The study 4 examines the disparity of amoxicillin dosing between the ages of children and finds that larger children are prescribed declining doses in mg/kg/d, with most patients above 60 kg being dosed at less than 40 mg/kg/d.
- The same study 4 mentions that children 6 years and under cluster around the 80 mg/kg/d dose, and older children receive a lower than recommended dose per kilogram of amoxicillin for conditions that require high-dose amoxicillin.
- The studies 5, 6, and 7 do not provide information on the maximum dose of amoxicillin for pediatric patients, as they focus on different aspects of antibiotic treatment, such as the efficacy of macrolides compared to amoxicillin-clavulanate, and the effectiveness of amoxicillin, azithromycin, cefprozil, and clarithromycin in treating acute otitis media in children.
Recommended Dose
- Based on the available information, the recommended dose of amoxicillin for pediatric patients can be up to 80-90 mg/kg/d, as mentioned in 4.
- However, it is essential to note that the dosing of amoxicillin may vary depending on the specific condition being treated, the age and weight of the child, and other factors, and should be determined by a healthcare professional.