Maximum Amoxicillin Dose for a 10-Year-Old Child
The maximum daily dose of amoxicillin for a 10-year-old child is 4000 mg (4 grams) per day, regardless of weight or indication. 1, 2
Weight-Based Dosing Framework
For a 10-year-old child weighing 28-40 kg, dosing depends on infection severity and type:
Standard Dosing for Mild to Moderate Infections
- 45 mg/kg/day divided every 12 hours for uncomplicated respiratory tract infections, skin infections, and genitourinary infections 1, 2
- For a 28 kg child: 1260 mg/day (630 mg twice daily)
- For a 40 kg child: 1800 mg/day (900 mg twice daily)
- This provides adequate coverage for most susceptible pathogens including Streptococcus pneumoniae and Streptococcus pyogenes 2
High-Dose Regimen for Severe Infections
- 90 mg/kg/day divided every 12 hours for severe infections or areas with high pneumococcal resistance 1, 2, 3
- For a 28 kg child: 2520 mg/day (1260 mg twice daily)
- For a 40 kg child: 3600 mg/day (1800 mg twice daily)
- This higher dose is specifically recommended for community-acquired pneumonia, particularly in children under 2 years, those with recent antibiotic exposure, or daycare attendance 2, 3
Critical Dosing Ceiling
Even if weight-based calculations exceed 4000 mg/day, the absolute maximum remains 4000 mg daily. 1, 2 For example:
- A 40 kg child at 90 mg/kg/day would calculate to 3600 mg/day (acceptable)
- A 45 kg child at 90 mg/kg/day would calculate to 4050 mg/day, but must be capped at 4000 mg/day 1
Indication-Specific Maximum Doses
Group A Streptococcal Infections
- 50-75 mg/kg/day divided into 2 doses for 10 days, not exceeding 1000 mg per dose 1, 2
- For a 28-40 kg child: maximum 1000 mg twice daily (2000 mg/day total)
- This lower maximum per-dose limit is specific to streptococcal pharyngitis 2
Community-Acquired Pneumonia
- 90 mg/kg/day in 2 doses with a maximum of 4000 mg/day 2, 3
- The American Academy of Pediatrics and Infectious Diseases Society of America both recommend this high-dose regimen for presumed bacterial pneumonia 3
Transition to Adult Dosing
For children weighing 40 kg or more, adult dosing regimens apply: 1
- Mild to moderate infections: 500 mg every 12 hours or 250 mg every 8 hours
- Severe infections: 875 mg every 12 hours or 500 mg every 8 hours
- Lower respiratory tract infections: 875 mg every 12 hours or 500 mg every 8 hours (regardless of severity)
Important Clinical Considerations
Renal Impairment
- Patients with GFR <30 mL/min should NOT receive the 875 mg dose 4
- For GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 1, 4
- For GFR <10 mL/min: 500 mg or 250 mg every 24 hours 1, 4
Dosing Frequency Advantage
- Twice-daily dosing (every 12 hours) improves adherence compared to three-times-daily regimens, making it the preferred approach 1
- The 45-90 mg/kg/day divided every 12 hours is superior to more frequent dosing schedules for compliance 1
Common Pitfalls to Avoid
- Never exceed 4000 mg/day total, even if weight-based calculations suggest higher doses 1, 2
- For streptococcal pharyngitis specifically, do not exceed 1000 mg per individual dose despite the higher daily maximum 1, 2
- Ensure treatment duration is at least 10 days for Streptococcus pyogenes infections to prevent rheumatic fever 1, 4
- Clinical improvement should occur within 48-72 hours; if not, reassess diagnosis and consider alternative antibiotics 1, 2