Amoxicillin Dosing for Uncomplicated Pneumonia in an 11kg Child
For an 11kg child with uncomplicated pneumonia, prescribe amoxicillin 45 mg/kg/day divided into 2 doses (approximately 250 mg twice daily) for 7-10 days. 1, 2
Recommended Dosing Regimen
Standard dose for mild-to-moderate uncomplicated pneumonia:
- 45 mg/kg/day divided into 2 doses 1, 2
- For an 11kg child: 495 mg/day total = approximately 250 mg twice daily 2
- This can be administered as 2.5 mL of 250 mg/5 mL suspension twice daily 2
When to Consider Higher Dosing
High-dose amoxicillin (90 mg/kg/day) should be used if: 1, 2
- The child attends daycare 1, 3
- Recent antibiotic use within the past 30 days 1, 3
- Age younger than 2 years 1
- Local pneumococcal resistance rates exceed 10% 1
- Severe infection or clinical deterioration 1
For high-dose regimen in this 11kg child: 990 mg/day = 500 mg twice daily (5 mL of 250 mg/5 mL suspension twice daily) 2
Treatment Duration
Treat for 7-10 days total: 2, 4, 5, 6
- Continue for minimum 48-72 hours beyond symptom resolution 7, 2
- Recent evidence demonstrates that 5-day courses may be equally effective as 10-day courses for uncomplicated pneumonia, though 7-10 days remains the guideline standard 5, 6
Administration Instructions
Give at the start of meals to minimize gastrointestinal side effects 7
- Shake suspension well before each dose 7
- Can be mixed with formula, milk, fruit juice, or water if needed, but must be taken immediately after mixing 7
- Store reconstituted suspension in refrigerator (preferred but not required); discard after 14 days 7
Monitoring and Follow-Up
Clinical improvement should occur within 48-72 hours: 2, 4
- If no improvement by 48-72 hours, reevaluate and consider atypical pathogens (Mycoplasma, Chlamydophila) requiring macrolide addition 1, 2
- Fever typically resolves within 24-48 hours for pneumococcal pneumonia 2
- Cough may persist longer than fever resolution 2
Critical Pitfalls to Avoid
Do not underdose: The standard 45 mg/kg/day dose provides adequate coverage for most Streptococcus pneumoniae and Haemophilus influenzae strains in areas with typical resistance patterns 1, 2
Do not use lower doses (20-25 mg/kg/day): These doses are insufficient for pneumonia treatment and are only appropriate for mild otitis media or pharyngitis 1, 8
Do not stop antibiotics early: Complete the full 7-10 day course even if symptoms improve before completion 2, 4
Do not delay escalation: If the child deteriorates or shows no improvement by 48-72 hours, consider adding azithromycin (10 mg/kg day 1, then 5 mg/kg days 2-5) for atypical coverage or switching to high-dose amoxicillin-clavulanate if β-lactamase-producing organisms are suspected 1, 2
Rationale for Twice-Daily Dosing
Twice-daily dosing is preferred over three-times-daily: 2, 8, 9