Amoxicillin Dosing for Pediatric Sinusitis

Standard vs High-Dose Regimens

The American Academy of Pediatrics recommends 45 mg/kg/day divided into two doses for uncomplicated acute bacterial sinusitis in children without risk factors for resistant organisms 1
The American Academy of Pediatrics recommends 90 mg/kg/day divided into two doses for high-dose therapy when antibiotic resistance is suspected or the child is at high risk 1, 2

Children with age younger than 2 years, recent antibiotic exposure, severe infection, or daycare attendance may require high-dose amoxicillin therapy 2, 3

The Infectious Diseases Society of America recommends amoxicillin-clavulanate 80-90 mg/kg/day for suspected β-lactamase-producing organisms 2, 3
Amoxicillin-clavulanate provides coverage against β-lactamase-producing H. influenzae and M. catarrhalis 1

The standard treatment duration is 10-14 days, with reassessment at 3-5 days if no clinical improvement is seen 2

First-generation cephalosporins, macrolides, and trimethoprim-sulfamethoxazole are no longer recommended due to high resistance rates 1, 3
Ceftriaxone 50 mg/kg IV/IM can be given as a single dose for children unable to tolerate oral medication, with transition to oral therapy if improvement occurs at 24 hours 2

High-dose amoxicillin/clavulanate is indicated for pediatric sinusitis at 90mg/kg/day of the amoxicillin component with 6.4mg/kg/day of clavulanate, divided into 2 doses, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4
The American Academy of Pediatrics and Infectious Diseases Society of America recommend high-dose amoxicillin/clavulanate (80-90mg/kg/day) for pediatric sinusitis to provide adequate coverage against β-lactamase-producing H. influenzae, M. catarrhalis, and potentially resistant S. pneumoniae 4
The 14:1 ratio of amoxicillin to clavulanate in the high-dose formulation minimizes gastrointestinal side effects while maintaining efficacy against resistant organisms, according to the American Academy of Otolaryngology-Head and Neck Surgery 4