What is the typical dosage of Amoxicillin (amoxicillin) for toddlers?

Amoxicillin Dosing for Toddlers

For toddlers with respiratory infections, prescribe amoxicillin at 90 mg/kg/day divided into 2 doses (given every 12 hours) for severe infections or areas with high pneumococcal resistance, or 45 mg/kg/day divided into 2 doses for mild to moderate infections, with a maximum daily dose of 4000 mg. 1, 2, 3, 4

Standard Dosing by Infection Severity

Mild to Moderate Respiratory Infections

• 45 mg/kg/day divided every 12 hours is the recommended dose for uncomplicated community-acquired pneumonia and other respiratory tract infections 1, 2, 3
• This provides adequate coverage for typical pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1
• The twice-daily dosing significantly improves adherence compared to three-times-daily regimens 3

Severe Infections or High Resistance Areas

• 90 mg/kg/day divided every 12 hours is indicated when pneumococcal resistance is suspected or confirmed 1, 2, 3
• This higher dose is necessary to achieve adequate middle ear and lung tissue penetration against penicillin-intermediate and resistant Streptococcus pneumoniae 1, 2
• The FDA label supports this dosing for lower respiratory tract infections at 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 4

Group A Streptococcal Infections (Including Scarlet Fever)

• 50-75 mg/kg/day divided into 2 doses for 10 days is recommended, not exceeding 1000 mg per dose 2, 3
• The 10-day duration is mandatory to prevent acute rheumatic fever 3, 4
• Patients become non-contagious after 24 hours of therapy 2, 3

Age-Specific Considerations for Toddlers

Children Under 3 Months (12 Weeks)

• Maximum dose is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 4
• No dosing recommendations exist for children under 3 months with renal impairment 4

Children 3 Months and Older, Weighing Less Than 40 kg

• Use weight-based dosing exclusively rather than age-based dosing 2, 3, 4
• For mild/moderate infections: 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours 4
• For severe infections: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 4

Treatment Duration

• 7-10 days for most respiratory infections, with pneumonia specifically requiring 10 days 2, 3
• 10 days mandatory for Group A Streptococcal infections to prevent rheumatic fever 2, 3, 4
• Continue treatment for a minimum of 48-72 hours beyond symptom resolution or evidence of bacterial eradication 4

Critical Prescription Elements

Every amoxicillin prescription must include:

• Total daily dose in mg/kg/day 3, 5
• Number of divided doses per day (preferably 2 for adherence) 3, 5
• Duration of therapy 3, 5
• Indication for prescription 3, 5
• Child's weight 5

Administration Guidelines

• Give at the start of meals to minimize gastrointestinal intolerance 4
• Oral suspension can be mixed with formula, milk, fruit juice, water, or cold drinks and taken immediately 4
• Shake suspension well before each use 4
• Refrigeration is preferable but not required; discard unused suspension after 14 days 4

Monitoring and Follow-Up

• Clinical improvement should occur within 48-72 hours of starting treatment 2, 3
• If no improvement by 72 hours, reassess the diagnosis and consider alternative antibiotics or resistant pathogens 3
• Complete the full prescribed course even if symptoms improve earlier 2

Common Adverse Effects

• Gastrointestinal disturbances (diarrhea, nausea, vomiting) are most common 2, 3
• Rash, urticaria, and hypersensitivity reactions may occur 2, 3
• Diarrhea is less frequent with twice-daily versus three-times-daily dosing 6

Critical Pitfalls to Avoid

• Do not use amoxicillin alone if MRSA is suspected - it will be ineffective and alternative antibiotics must be considered 3
• Do not prescribe the 875 mg tablet formulation to children with severe renal impairment (GFR <30 mL/min) 4
• Avoid underdosing in areas with high pneumococcal resistance - the traditional 40 mg/kg/day is inadequate for resistant strains, particularly during viral coinfection 7
• Do not use age-based dosing - always calculate based on actual body weight 3, 5