What is the appropriate dosing of amoxicillin (amoxicillin) for Lower Respiratory Tract Infection (LRTI) in a 14-month-old child?

From the Guidelines

For a 14-month-old child with a lower respiratory tract infection (LRTI), the recommended dosage of amoxicillin is 90 mg/kg/day in 2 doses. This dosage is based on the guidelines from the Pediatric Community Pneumonia Guidelines 1, which recommend amoxicillin as the first-line treatment for presumed bacterial pneumonia in children under 5 years old. The guidelines suggest that the amoxicillin component should be 90 mg/kg/day in 2 doses, with a maximum dose of 4000 mg/day. For a typical 14-month-old weighing approximately 10-11 kg, this would translate to about 450-495 mg twice daily.

• The exact dose should be calculated based on the child's actual weight for precision.
• High-dose amoxicillin is preferred if Streptococcus pneumoniae with reduced susceptibility is suspected or in areas with high prevalence of resistant organisms.
• The liquid formulation typically comes as 125 mg/5 mL or 250 mg/5 mL suspension, so measure carefully using the provided dosing device.
• Ensure the full course is completed even if symptoms improve before the medication is finished.
• Watch for side effects including diarrhea, rash, or signs of allergic reaction.
• If the child has a penicillin allergy, alternative antibiotics like azithromycin may be considered, as suggested by the British Thoracic Society guidelines 1.
• Amoxicillin is effective against common LRTI pathogens in children including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with good penetration into respiratory tissues.

From the FDA Drug Label

Infections of the Lower Respiratory Tract: Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus spp. (α-and β-hemolytic isolates only), S. pneumoniae, Staphylococcus spp., or H. influenzae.

Table 1 ... Lower Respiratory Tract Mild/ Moderate or Severe 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

For a 14-month-old patient, the recommended dosage of amoxicillin for Lower Respiratory Tract Infections (LRTI) is:

• Mild/Moderate or Severe: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours 2

From the Research

Amoxicillin Dosing for LRTI in Children

• The appropriate dosing of amoxicillin for lower respiratory tract infections (LRTI) in children is a crucial aspect of treatment, but there is limited randomized evidence to support its effectiveness 3.
• According to the study by 3, children aged 1-12 years with acute uncomplicated LRTI were randomized to receive 50 mg/kg/day of oral amoxicillin in divided doses for 7 days, or placebo.
• The study found that the duration of moderately bad symptoms was similar in the antibiotic and placebo groups overall, with a median of 5 and 6 days, respectively.
• For a 14-month-old child, the dosing would be based on their weight, with a typical dose of 50 mg/kg/day divided into multiple doses 3.

Considerations for Amoxicillin Use in Children

• The use of amoxicillin in children with LRTI should be guided by the principles of antimicrobial stewardship, with consideration of the potential risks and benefits of treatment 4.
• The choice of antibiotic and dosage should be based on the severity of the infection, the suspected or confirmed causative pathogen, and the child's age, weight, and renal function 5.
• It is essential to note that amoxicillin may not be effective against all types of LRTI, and its use should be tailored to the specific clinical scenario 6.

Clinical Decision-Making

• Clinicians should consider the clinical presentation, medical history, and laboratory results when deciding whether to prescribe amoxicillin for a child with LRTI 3.
• The decision to use amoxicillin should be based on a thorough evaluation of the child's condition, including the severity of symptoms, the presence of comorbidities, and the potential for complications 5.
• Parents and caregivers should be educated on the appropriate use of antibiotics, the potential risks and benefits of treatment, and the importance of completing the full course of therapy as prescribed 3.