Amoxicillin Oral Suspension Dosing for Pediatric Strep Throat
For children with strep throat, administer amoxicillin oral suspension at 50 mg/kg once daily (maximum 1000 mg) for 10 days, which is the preferred first-line treatment with strong, high-quality evidence. 1, 2
Primary Dosing Regimens
Once-daily dosing is the recommended approach:
- 50 mg/kg once daily (maximum 1000 mg) for 10 days 1, 2
- This regimen demonstrates superior efficacy and compliance compared to penicillin V 3, 4
Alternative twice-daily dosing if once-daily is not feasible:
- 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1, 2
- Both regimens show equivalent efficacy 1
Critical Treatment Considerations
Duration is non-negotiable:
- All oral regimens must be completed for the full 10 days to prevent acute rheumatic fever, regardless of symptom resolution 1, 2, 5
- This duration is specifically required for Group A Streptococcus to prevent nonsuppurative complications 1
Preparation and administration:
- Reconstitute suspension according to bottle instructions (see FDA label for specific volumes) 5
- Administer at the start of a meal to minimize gastrointestinal intolerance 5
- Shake suspension well before each use 5
- Discard unused suspension after 14 days; refrigeration is preferable but not required 5
When Standard Amoxicillin Fails
Reserve amoxicillin/clavulanate (Augmentin) for:
- Treatment failures after initial therapy 2, 6
- Chronic Group A Streptococcus carriers who failed first-line eradication 2, 6
- Dosing: 40 mg/kg/day of amoxicillin component divided into three doses (maximum 2000 mg/day) for 10 days 2, 6
Penicillin Allergy Alternatives
For non-immediate hypersensitivity reactions:
- Cephalexin 20 mg/kg twice daily (maximum 500 mg/dose) for 10 days 1, 2
- Cefadroxil 30 mg/kg once daily (maximum 1 g) for 10 days 1, 2
For immediate-type hypersensitivity (avoid all β-lactams):
- Clindamycin 7 mg/kg three times daily (maximum 300 mg/dose) for 10 days 1, 2
- Azithromycin 12 mg/kg once daily (maximum 500 mg) for 5 days—use with caution due to geographic resistance patterns 1, 2
- Clarithromycin 7.5 mg/kg twice daily (maximum 250 mg/dose) for 10 days—resistance is common and varies geographically 1, 7
Clinical Monitoring
Assess treatment response:
- Expect clinical improvement within 24-48 hours 2, 8
- If no improvement by 48-72 hours, reassess diagnosis or consider alternative antibiotics 2, 8
- Evaluate for recent antibiotic use in previous 4-6 weeks, which increases risk of resistant organisms 2
Common pitfall to avoid:
- Do not routinely perform post-treatment throat cultures unless symptoms persist 8
- Carriers (asymptomatic children with positive cultures after treatment) do not require additional therapy 1
Special Populations
For children under 3 months:
- Maximum dose is 30 mg/kg/day divided every 12 hours due to immature renal function 5
For severe renal impairment (GFR <30 mL/min):
- Do NOT use the 875 mg tablet formulation 5
- Adjust dosing based on creatinine clearance per FDA guidelines 5
For compliance concerns: