What is the appropriate dosage of Amoxicillin (amoxicillin) for a 27.2kg pediatric patient?

Amoxicillin Dosing for a 27.2kg Pediatric Patient

For a 27.2kg child, the standard amoxicillin dose is 50 mg/kg/day divided into 2 doses (approximately 680 mg twice daily or 13.6 mL of 250mg/5mL suspension twice daily) for most common infections, with treatment duration of 10 days for streptococcal infections. 1, 2

Weight-Based Dosing Algorithm

Standard Dosing for Common Infections

• For Group A Streptococcal pharyngitis (strep throat): The recommended dose is 50-75 mg/kg/day divided into 2 doses for 10 days, which translates to 680-1020 mg twice daily (13.6-20.4 mL of 250mg/5mL suspension twice daily) for this 27.2kg patient 1, 2

• For mild to moderate respiratory tract infections: The dose is 45 mg/kg/day divided every 12 hours, which equals approximately 612 mg twice daily (12.2 mL of 250mg/5mL suspension twice daily) 2, 3

• For severe respiratory infections or high pneumococcal resistance areas: The dose increases to 90 mg/kg/day divided every 12 hours, which equals approximately 1224 mg twice daily (24.5 mL of 250mg/5mL suspension twice daily) 2, 3

Critical Dosing Considerations

• The maximum single dose should not exceed 1000 mg per dose for streptococcal infections, even though this patient's calculated dose may be higher 2

• Treatment must continue for at least 10 days for any Streptococcus pyogenes infection to prevent acute rheumatic fever 1, 3

• Treatment should continue for a minimum of 48-72 hours beyond symptom resolution for respiratory infections 3

Indication-Specific Guidance

For Streptococcal Pharyngitis

• Amoxicillin is often preferred over penicillin V in children due to better taste acceptance and twice-daily dosing improving adherence 2

• The standard regimen is 50 mg/kg/day divided into 2 doses (not exceeding 1000 mg per dose) for 10 days 1, 2

For Community-Acquired Pneumonia

• Mild to moderate cases: 45 mg/kg/day divided every 12 hours for 10 days 2

• Severe cases or areas with >10% penicillin-resistant S. pneumoniae: 90 mg/kg/day divided every 12 hours for 10 days 2

• Children should demonstrate clinical improvement within 48-72 hours; if no improvement occurs, reevaluation is necessary 2

Practical Administration

Using 250mg/5mL Suspension

• For standard strep throat dosing (50 mg/kg/day): Give 13.6 mL twice daily 2

• For mild respiratory infections (45 mg/kg/day): Give 12.2 mL twice daily 2

• For severe infections (90 mg/kg/day): Give 24.5 mL twice daily 2

Important Administration Instructions

• Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 3

• Shake oral suspension well before each use 3

• Refrigeration is preferable but not required; discard any unused portion after 14 days 3

Common Pitfalls to Avoid

• Do not underdose: At 27.2kg, this patient is above the 27kg threshold where adult dosing considerations begin, but weight-based dosing remains appropriate 1

• Do not shorten treatment duration: Even if symptoms resolve quickly, complete the full 10-day course for streptococcal infections to prevent rheumatic fever 1, 3

• Do not use for viral pharyngitis: Only prescribe when Group A Streptococcus is confirmed by rapid antigen detection test or throat culture 1

When to Consider Higher Dosing

Higher doses (90 mg/kg/day) are warranted when: 2

• The patient has severe infection requiring hospitalization
• There is recent antibiotic exposure within the past 30 days
• Local pneumococcal resistance rates exceed 10%
• The patient attends daycare
• The patient is under 2 years old (not applicable here)