What is the preferred concentration of amoxicillin (amoxicillin trihydrate) for reconstitution in pediatric patients?

Preferred Concentration of Amoxicillin for Reconstitution in Pediatric Patients

The preferred concentration for reconstituting amoxicillin oral suspension in pediatric patients is 250 mg/5 mL, as this formulation provides optimal dosing flexibility for weight-based pediatric dosing while minimizing administration volume and improving palatability. 1

Reconstitution Guidelines

The FDA-approved amoxicillin oral suspension is available in two standard concentrations 1:

• 125 mg/5 mL concentration: Requires larger volumes for higher doses, making it less practical for most pediatric patients requiring standard or high-dose therapy 1
• 250 mg/5 mL concentration: Provides better dosing precision and smaller administration volumes, making it the preferred choice for most pediatric indications 1

Reconstitution Instructions

When preparing amoxicillin oral suspension, follow this specific protocol 1:

• Tap the bottle until all powder flows freely 1
• Add approximately one-third of the required water (see specific volumes below) to the powder 1
• Replace cap and shake vigorously to wet the powder 1
• Add the remaining water, replace cap, and shake vigorously again 1

Water Requirements for Reconstitution

For 125 mg/5 mL suspension 1:

• 80 mL bottle: Add 70 mL water
• 100 mL bottle: Add 87 mL water
• 150 mL bottle: Add 130 mL water

For 250 mg/5 mL suspension 1:

• 80 mL bottle: Add 56 mL water
• 100 mL bottle: Add 70 mL water
• 150 mL bottle: Add 105 mL water

Clinical Dosing Considerations

The 250 mg/5 mL concentration is particularly advantageous because 2, 3, 1:

• Standard dosing (45 mg/kg/day): For mild to moderate respiratory infections, this concentration allows for practical twice-daily dosing 2, 3
• High-dose therapy (90 mg/kg/day): For severe infections or high-resistance areas, the 250 mg/5 mL concentration minimizes the volume required to achieve recommended doses 2, 3
• Maximum daily dose: The concentration supports dosing up to 4000 mg/day in older children without requiring excessive volumes 2, 1

Administration and Storage

Critical administration points 1:

• Shake the oral suspension well before each use 1
• Administer at the start of a meal to minimize gastrointestinal intolerance 1
• Place the required amount directly on the child's tongue, or mix with formula, milk, fruit juice, water, ginger ale, or cold drinks 1
• If mixed with other liquids, administer immediately 1

Storage requirements 1:

• Keep the bottle tightly closed 1
• Refrigeration is preferable but not required 1
• Discard any unused portion after 14 days 1

Common Pitfalls to Avoid

• Incorrect water volume: Using the wrong amount of water results in incorrect drug concentration and dosing errors 1
• Inadequate shaking: Failure to shake vigorously during reconstitution and before each dose leads to inconsistent drug delivery 1
• Delayed administration: When mixed with other liquids, the preparation must be taken immediately to ensure full dose delivery 1
• Extended storage: Using suspension beyond 14 days after reconstitution may result in reduced potency 1