Is 7 ml of amoxicillin (400 mg/5ml) BID (twice a day) for 10 days an appropriate dose for a 5-year-old child weighing 21.3 kg?

Amoxicillin Dosing Assessment for 5-Year-Old Child

The prescribed dose of 7 mL of amoxicillin 400 mg/5 mL BID (560 mg twice daily, total 1120 mg/day) for this 21.3 kg child is APPROPRIATE for most common pediatric infections, providing approximately 52.6 mg/kg/day, which falls within the standard dosing range for mild to moderate respiratory tract infections. 1, 2

Dose Calculation and Verification

Weight-based calculation:

• Child's weight: 21.3 kg
• Prescribed dose: 7 mL of 400 mg/5 mL = 560 mg per dose
• Frequency: BID (twice daily)
• Total daily dose: 1120 mg/day = 52.6 mg/kg/day 2

This dosing is appropriate for:

• Mild to moderate respiratory tract infections (standard dose: 45 mg/kg/day divided every 12 hours) 1, 2
• Ear/nose/throat infections (standard dose: 25 mg/kg/day for mild infections, 45 mg/kg/day for severe) 2
• Skin and skin structure infections 2
• Genitourinary tract infections 2

Clinical Context Considerations

For standard infections, the American Academy of Pediatrics recommends 45 mg/kg/day divided every 12 hours for uncomplicated respiratory tract infections, which would be approximately 960 mg/day for this child 1. The prescribed dose of 1120 mg/day (52.6 mg/kg/day) is slightly higher but well within safe limits and provides additional coverage. 1

If this is for community-acquired pneumonia or high-resistance areas, the prescribed dose is SUBOPTIMAL. The Infectious Diseases Society of America recommends 90 mg/kg/day (approximately 1917 mg/day for this child) for severe infections, areas with >10% penicillin-resistant S. pneumoniae, recent antibiotic exposure, or daycare attendance. 1 In such cases, the dose should be increased to approximately 12 mL BID (960 mg per dose, 1920 mg/day). 1

Duration Assessment

The 10-day duration is APPROPRIATE for most pediatric infections, particularly:

• Group A Streptococcal infections (requires minimum 10 days to prevent acute rheumatic fever) 1, 2
• Community-acquired pneumonia (standard 10-day course) 1
• Acute bacterial sinusitis 1

The FDA label specifies treatment should continue for a minimum of 48-72 hours beyond symptom resolution, with at least 10 days for Streptococcus pyogenes infections. 2

Safety Parameters

Maximum dose considerations:

• The maximum daily dose of amoxicillin should not exceed 4000 mg/day regardless of weight 1
• This child's dose of 1120 mg/day is well below this threshold 1
• No dose adjustment needed for normal renal function 2

Critical Clinical Caveats

Expect clinical improvement within 48-72 hours of initiating therapy; if no improvement occurs, reevaluation is necessary to consider resistant organisms or alternative diagnoses. 1

For β-lactamase-producing organisms (H. influenzae, M. catarrhalis), amoxicillin-clavulanate (Augmentin) at 90 mg/kg/day of the amoxicillin component would be more appropriate than amoxicillin alone. 1, 3

Administration instructions: Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance. 2 The suspension must be shaken well before each use and any unused portion discarded after 14 days. 2

Common adverse effects include gastrointestinal disturbances (diarrhea, nausea), rash, and urticaria, which should be monitored. 1