What is the recommended dose of Amoxil (amoxicillin) for a 14kg child with a lower respiratory tract infection?

Amoxicillin Dosing for a 14kg Child with Lower Respiratory Tract Infection

For a 14kg child with lower respiratory tract infection, administer amoxicillin 630mg per day divided into two doses (315mg twice daily), which equals approximately 6.3mL of 250mg/5mL suspension twice daily for 10 days. 1

Dosing Algorithm

Standard Dosing (First-Line)

• The recommended dose is 45 mg/kg/day divided into 2 doses for mild to moderate lower respiratory tract infections 1, 2
• For a 14kg child: 14kg × 45mg/kg = 630mg total daily dose
• Administer as 315mg (approximately 6.3mL of 250mg/5mL suspension) twice daily 1
• Treatment duration: 10 days 1

High-Dose Regimen (When Indicated)

• Use 90 mg/kg/day divided into 2 doses if the child has risk factors for resistant organisms 1, 2
• Risk factors include:
  • Age <2 years 1
  • Daycare attendance 1, 2
  • Recent antibiotic use within past 30 days 1, 2
  • Geographic area with high pneumococcal resistance (>10%) 1
  • Moderate to severe illness 1
• For a 14kg child with risk factors: 14kg × 90mg/kg = 1,260mg total daily dose
• Administer as 630mg (approximately 12.6mL of 250mg/5mL suspension) twice daily 1

Clinical Monitoring

Expected Response Timeline

• Clinical improvement should be evident within 48-72 hours of starting therapy 1
• Fever typically resolves within 24-48 hours for pneumococcal pneumonia, though cough may persist longer 3
• If no improvement or worsening occurs after 48-72 hours, reevaluation is necessary 1

Treatment Failure Management

• If amoxicillin fails after 48 hours, consider atypical bacteria (Mycoplasma, Chlamydophila) and add or switch to a macrolide 3
• For suspected β-lactamase-producing organisms (H. influenzae, M. catarrhalis), switch to amoxicillin-clavulanate 90mg/kg/day of amoxicillin component 1, 4
• Hospitalization should be considered after 5 days without improvement 3

Important Clinical Considerations

Administration

• Administer at the start of meals to minimize gastrointestinal intolerance 5
• Shake oral suspension well before each use 5
• Refrigeration is preferable but not required; discard unused suspension after 14 days 5

Common Pitfalls to Avoid

• Do not use the older 40mg/kg/day dosing regimen - this is inadequate for current resistance patterns 6
• The British Thoracic Society guidelines from 2002 suggest lower doses that are now outdated 3; current evidence supports 45-90mg/kg/day 1
• Twice-daily dosing is equally effective as three-times-daily dosing and improves compliance 7, 8
• Ensure complete 10-day course even if symptoms improve earlier 1

When Antibiotics May Not Be Needed

• Recent high-quality evidence shows that amoxicillin for uncomplicated (non-pneumonic) chest infections in children provides minimal clinical benefit 9
• If pneumonia is not clinically suspected, consider safety-netting advice without antibiotics 9
• The median symptom duration was similar between amoxicillin (5 days) and placebo (6 days) groups in uncomplicated lower respiratory tract infections 9

Special Populations

• For children with incomplete H. influenzae type b vaccination (<3 injections) or concurrent purulent acute otitis media, use amoxicillin-clavulanate instead of amoxicillin alone at 80-90mg/kg/day of amoxicillin component 3, 1
• For children under 3 months, maximum dose is 30mg/kg/day divided every 12 hours due to immature renal function 5