Amoxicillin Dosing for Pediatric Bronchopneumonia
No, the recommended dosage is not 30 mg/kg/dose—it is 90 mg/kg/day divided into 2 doses (or 45 mg/kg/dose twice daily) for pediatric community-acquired pneumonia, including bronchopneumonia. 1, 2, 3
Correct Dosing Regimen
The standard of care is amoxicillin 90 mg/kg/day divided into 2 doses for all children with presumed bacterial pneumonia. 4, 1, 2 This translates to approximately 45 mg/kg/dose given twice daily, not 30 mg/kg/dose.
Age-Specific Recommendations
- Children under 5 years: Amoxicillin 90 mg/kg/day in 2 divided doses 1, 2
- Children 5 years and older: Amoxicillin 90 mg/kg/day in 2 divided doses (maximum 4 g/day) 1, 2, 3
Alternative Dosing Schedule
The guidelines also support amoxicillin 45 mg/kg/day divided into 3 doses (15 mg/kg/dose three times daily), but the twice-daily regimen at the higher total daily dose is preferred. 4 Research demonstrates that 50 mg/kg/day given twice daily is as efficacious as three times daily dosing. 5
Critical Pitfall: Underdosing
Underdosing amoxicillin with standard doses of 40-45 mg/kg/day (which would be approximately 20-22.5 mg/kg/dose twice daily) is a common and dangerous error that can lead to treatment failure due to resistant pneumococci. 1, 3 The higher dose of 90 mg/kg/day is essential to overcome pneumococcal resistance patterns currently seen in North America. 4, 3
Pathogen-Specific Context
For Streptococcus pneumoniae (the most common bacterial cause of pediatric pneumonia), the recommended oral treatment is specifically amoxicillin 90 mg/kg/day in 2 doses. 4, 1 For Group A Streptococcus, the oral dose is lower at 50-75 mg/kg/day in 2 doses. 4
Clinical Monitoring
Children on adequate therapy should demonstrate clinical improvement within 48-72 hours. 1, 2 If the child's condition deteriorates or shows no improvement within this timeframe, reevaluation and consideration of alternative pathogens (including MRSA) or complications is necessary. 1, 3