Amoxicillin Dosing Guidelines for Pediatric Patients

Dosing Considerations

For most common bacterial infections in children, amoxicillin should be dosed at 45 mg/kg/day in divided doses every 12 hours (twice daily) for mild to moderate infections, as recommended by the American Academy of Pediatrics 1, 2
For more severe infections, particularly respiratory tract infections, the dose can be increased to 90 mg/kg/day in divided doses every 12 hours, according to the Infectious Diseases Society of America 1, 2
For community-acquired pneumonia in children ≥5 years old, the recommended dose is 90 mg/kg/day in 2 doses (maximum 4 g/day), as suggested by the Pediatric Infectious Diseases Society 2, 3
For streptococcal pharyngitis, the dose is 50-75 mg/kg/day in 2 doses, as recommended by the American Academy of Pediatrics 4
For otitis media, the recommended dose is 40-45 mg/kg/day in 2 divided doses, according to the American Academy of Pediatrics 5, 6

The WHO recommends a 5-day amoxicillin-based empiric treatment for community-acquired pneumonia, with a strength of evidence rated as high 5
For otitis media, a 5-day course is typically sufficient, as suggested by the American Academy of Pediatrics 5
Avoid underdosing, which can lead to treatment failure and promote antimicrobial resistance, as warned by the Centers for Disease Control and Prevention 5
Be aware that amoxicillin dosing recommendations have increased over time due to increasing pneumococcal resistance, as noted by the Infectious Diseases Society of America 1, 2

For a 70-pound child, the standard dose (45 mg/kg/day) is approximately 1431 mg/day or 720 mg twice daily, as calculated using the conversion factor 1 kg = 2.2 lbs 6
The higher dose (90 mg/kg/day) is approximately 2862 mg/day or 1430 mg twice daily, as recommended by the American Academy of Pediatrics for more severe infections or resistant organisms 1, 2

Amoxicillin can be given without regard to meals, though administration with food may improve gastrointestinal tolerability 7
Oral suspension is typically used for children, with a concentration of 6 mg/mL commonly available, and for a 238 mg dose, approximately 40 mL of 6 mg/mL suspension is used 7
For a 476 mg dose, approximately 79 mL of 6 mg/mL suspension is used 7

Clinical improvement should occur within 48-72 hours of starting therapy, and if no improvement is seen, treatment failure, atypical pathogens, or complications should be considered, according to the Infectious Diseases Society of America 8
The American Academy of Pediatrics recommends completing the full course of antibiotics even if symptoms resolve earlier to prevent resistance and recurrence, although this fact is not directly cited, a similar recommendation is found in the context of 8

In children who show no clinical improvement or whose symptoms worsen after 48–72 hours of amoxicillin therapy, clinicians should reassess the diagnosis and consider that treatment failure may have occurred. 9

When treatment failure is suspected, switching to amoxicillin‑clavulanate at a total amoxicillin dose of 90 mg/kg/day (with the clavulanate component dosed at 6.4 mg/kg/day) is recommended. 9