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“Antibiotics? No, my God, I won’t use them!”
Antibiotics are medications used to treat bacterial infections. The most common antibiotic prescribed is amoxicillin. However, as every medication prescribed to a child could concern parents, we discuss amoxicillin dosage for a child in this post. Therefore, you may gather all the information before giving it to your children. Previously, the medicine was prescribed frequently. However, these days, it is only being prescribed if deemed necessary to avoid any future complications. However, if your doctor has prescribed amoxicillin, there are a few points that you must remember that we discuss in the post, along with its usage, dosage, and side effects.
What Is Amoxicillin?
Amoxicillin is a penicillin antibiotic used for treating bacterial infections including strep throat, skin infections, pneumonia, sinusitis, bronchitis, urinary tract infections and middle ear infections (1). However, this medicine is not recommended for treating any viral infections such as flu or cold (2).
The World Health Organization has listed amoxicillin as the most effective and safe medicine for children. It is available as capsules, chewable tablets, tablets, and oral suspensions, and is usually given three times a day in eight-hour intervals or as prescribed by a doctor (3).
Amoxicillin is available in the US market under the brand name Amoxil, Amoxicot, Moxatag, Trimox, DisperMox, and Moxilin.
When Is Amoxicillin Prescribed For Your Child?
Amoxicillin is prescribed for the below ailments:
- Whooping cough or pneumonia
- Worsened sinus infection
- Prolonged cough of more than 14 days
- A recurrent fever of 102° F
- Yellow-green nasal discharge
- Lower respiratory throat infection (lung infection)
- Otitis media (ear infection)
- E.coli-induced UTI
- Amoxicillin dosage for strep throat in children is decided based on the result of a throat culture and rapid strep test.
The antibiotic is also used for:
- Severe malnutrition in children (4). pr
- Stomach ulcers caused by H.pylori infection (used in combination with another antibiotic clarithromycin) (5).
- Stomach acids (used in combination with lansoprazole) (6).
- Pneumonia in infants (in combination with gentamicin) (7).
As the medicine is available in various forms, which one is the best for your child? Or what would the doctor prescribe?
How To Use/ Not Use Amoxicillin For Children?
Here is how you can take the drug in various forms:
- When taken as a capsule, it should be swallowed with a glass of milk, juice or water.
- When taking as an oral suspension, dilute the medicine with milk or water using a dosing syringe or a special dose-measuring spoon or a medicine cup. For infants and babies, you can mix the medicine with breastmilk or formula and place it directly on the tongue.
- When taking a chewable tablet, ask your child to chew the tablet well before swallowing.
- When taking ER tablets, do not chew or crush the tablet but swallow with water or milk.
The antibiotic needs to be taken as per the instructions on the label or as told by your doctor. It can be taken with or without food.
There are a few more things for you to make a note of:
- The drug interacts with over-the-counter and prescription medicines, vitamins and herbal products. So, if your child is taking any of these medicines, inform your physician about it before he prescribes amoxicillin. (Scroll down for the list)
- Make a note of the medicines, foods, preservatives, dyes, and animals to which your child is allergic, and share it with the doctor.
- Amoxicillin can cause serious allergies in kids. One such allergic reaction is called anaphylaxis (8). It is associated with symptoms like tightness or swelling of the throat and difficulty in breathing. Your child might look pale and floppy. This condition needs immediate medical attention.
- If your child has any kidney issues, asthma, hay fever, hives, or phenylketonuria, then your doctor should know about it.
Here is a list of drugs that amoxicillin interacts with and is commonly avoided together:
- Chlortetracycline
- Demeclocycline
- Cholera vaccine, live
- Lymecycline
- Doxycycline
- Methotrexate
- Meclocycline
- Minocycline
- Methacycline
- Rolitetracycline
- Oxytetracycline
- Venlafaxine
- Warfarin
- Tetracycline
However, some combinations do work well for treating certain diseases. In such cases, the doctor can alter the dosage to make the best use of both the medicines.
Now that you know the ‘ifs and buts’ of amoxicillin, let’s see a few of its features.
Characteristics Of Amoxicillin
- The antibiotic is easily absorbed by the gastrointestinal tract. It gets diffused into the body fluids and tissues, except into the brain and spinal fluids.
- It is a narrow microbiologic spectrum antibiotic (9), which targets specific gram positive or gram negative bacteria.
- Amoxicillin comes in a good flavor and you don’t need to run behind your kids to give this medicine.
Amoxicillin should be given in the right amount, no less and no more than what is recommended.
Amoxicillin Dosage Chart Based On The Child’s Weight/ Age
The dosage could vary depending on the condition and its severity. Given below is the list of recommended amoxicillin dosages for kids:
1. Ear/nose/throat infection (10)
| Mild/Moderate infection dose | Severe infection dose | |
|---|---|---|
| Children ≥ 40 kg | 500mg twice daily Or 250mg thrice daily | 875mg twice daily Or 250mg thrice daily |
| Children > 3 months and less than 40kg | 25mg/kg/day every 12 hours Or 20mg/kg/day every 8 hours | 45mg/kg/day every 12 hours Or 40mg/kg/day every 8 hours |
2. Skin/skin structure infection
| Mild/Moderate infection dose | Severe infection dose | |
|---|---|---|
| Children ≥ 40kg | 500mg twice daily Or 250mg thrice daily | 875mg twice daily Or 250mg thrice daily |
| Children > 3 months and less than 40kg | 25mg/kg/day every 12 hours Or 20mg/kg/day every 8 hours | 45mg/kg/day every 12 hours Or 40mg/kg/day every 8 hours |
3. Urinary tract infection
| Mild/Moderate infection dose | Severe infection dose | |
|---|---|---|
| Children ≥ 40kg | 500mg twice daily Or 250mg thrice daily | 875mg twice daily Or 250mg thrice daily |
| Children > 3 months and less than 40kg | 25mg/kg/day in divided doses every 12 hours Or 20mg/kg/day in divided doses every 8 hours | 45mg/kg/day in divided doses every 12 hours Or 40mg/kg/day in divided doses every 8 hours |
4. Lyme disease (10)
| By weight | Mild/Moderate infection dose | Severe infection dose |
|---|---|---|
| Children ≥ 40kg | 500mg to 1g every 8 hours (up to max 4g/day) in divided doses for 14 days | 500mg to 2g every 8 hours (up to max 6g/day) in divided doses for 10-30 days |
| Children < 40kg | 25 to 50mg/kg/day in three divided doses for 10 to 21 days. | 100mg/kg/day in three divided doses for 10 to 30 days. |
5. Community acquired pneumonia
| By weight | Dose |
|---|---|
| Children ≥ 40kg and more than 5 years | 500mg to 1g in every 8 hours |
| Children < 40kg aged two months to 5 years | 20 to 90mg/kg/day in divided doses |
Amoxicillin clavulanate potassium combination is used in the lowest dose to bring down the adverse gastrointestinal drug effects. It is available in the form of suspension, chewable tablet, and tablet. The clavulanic acid in amoxicillin and clavulanate potassium formulation prevents amoxicillin degradation by β-lactamase enzymes. This extends the antibiotic spectrum of amoxicillin to many bacteria that are normally resistant to the drug.
Dosage:
- The average dosage is 30mg/ kg of the child’s weight/ day.
- Children above three months of age weighing up to 40kg – 25-45mg/kg/day, divided and given every 12 hours. For this age group usually, a suspension or chewable tablet is prescribed due to the clavulanic acid component.
- Children weighing more than 40kg – 500-875mg, divided and given every 12 hours. Usually, a tablet is prescribed.
Once the child starts taking medicine, she should be feeling better by the second day.
The above dosages are a broad standard and they may or may not be suitable for all children.
Note: If your child vomits within 30 minutes of taking medicine, then give the same dose again. You don’t have to repeat the dose if she vomits after 30 minutes.
What If You Missed A Dose Or Gave An Overdose?
If your child misses an amoxicillin dose of the course, give it as early as you remember. But, if you remember just before the time for the next dose, then leave out the missed one and continue with the regular schedule.
An overdose of amoxicillin may cause allergic reactions. A mild overdose does not pose any serious problems. However, an excess amount could damage your child’s kidneys, and lead to behavioral changes, confusion, severe skin rashes, pain in lower back, nausea, and less urination. In such cases, take them to the doctor immediately.
How Can An Overdose Of Amoxicillin Be Treated?
In a case of amoxicillin overdose, the doctor may prescribe some other medicines to control the side effects, or insert a tube into the stomach to pump out the excess dose. Some supportive treatments involve diuretic medications to prevent damage to the kidney and provide fluids through an intravenous line.
Treatment would depend on the extent of the effect on your child.
It is not just the overdose sometimes a normal amoxicillin dose could also have an adverse effect.
Amoxicillin Side-effects In Children:
While taking amoxicillin, your child may experience certain discomforts. Consult your doctor if she exhibits any of the following symptoms (11):
- Vomiting, diarrhea, or stomach pain. In case of vomiting and nausea, you may try giving the medicine after meals
- Diarrhea gets severe and watery, contains blood or continues for more than four days
- White patches inside your child’s mouth and throat
- Soreness or itching around the vagina, in the case of girls
- Breathing or wheezing problems
- Blistering, redness, peeling of skin, yellowing of skin or eyes
- Some allergic reactions such as hives, skin rashes, itching or swelling of lips, face, and tongue
- Unusual bleeding or bruising
- Fatigue and weakness
- Heavy menstrual flow in girls
- Loss of appetite
- Decreased urination
- Burning sensation or pain while urinating
Some of the side effects are temporary. Once the body adjusts to the medicine, the symptoms will go away and do not need any medical assistance. However, take your child to the doctor to avoid any severe health issues.
Amoxicillin For Kids: Important Points To Remember
- It is necessary to complete the course of the antibiotic. If it is discontinued, the bacteria might multiply, thereby leading to the onset of infection again.
- Store the medicine in cool temperature after you mix it.
- If your child has vomiting or diarrhea, then make them drink more water or any other fluid to replenish the loss.
- Do not give any medication for diarrhea unless it has been prescribed by your doctor.
- Give the amoxicillin dose at a fixed time every day and in the right amount.
- Your child’s teeth may look yellow or brown or might get gray stains. In such case, visit a dentist and get their teeth cleaned up.
- Give the medicine only to the child for whom it has been prescribed. It should not be shared with other children, even if they have similar symptoms.
- Unless your doctor recommends, children should not be given medicines containing ibuprofen or paracetamol along with this antibiotic.
- If your child has diabetes, then amoxicillin may interfere with the glucose tests giving false results. In such case, you must ask the doctor for alternative sugar tests.
Amoxicillin is a common and safe antibiotic for children to treat different bacteria-induced illnesses. However, even though it is widely used, it is better to stay informed about any medication given to children to maintain safety. The amoxicillin dosage for kids varies depending on the prescribed condition. Therefore follow your pediatrician’s advice and prescription for the antibiotic course. Remember to take the necessary precautions and look out for any adverse reactions in your children and consult a doctor when necessary.
References:
- Use of penicillin antibiotics
https://www.medicinesinpregnancy.org/Medicine–pregnancy/Amoxicillin/ - Amoxicillin.
https://medlineplus.gov/druginfo/meds/a685001.html - Amoxicillin.
https://www.healthnavigator.org.nz/medicines/a/amoxicillin/ - Amoxicillin for Acute Malnutrition in Children.
https://www.nejm.org/do/10.1056/NEJMdo005050/full/ - Amoxicillin.
https://www.mottchildren.org/health-library/d00088a1 - Lansoprazole Clarithromycin and Amoxicillin.
https://medlineplus.gov/druginfo/meds/a601067.html - C Darras-Joly et al; Synergy between amoxicillin and gentamicin in combination against a highly penicillin-resistant and -tolerant strain of Streptococcus pneumoniae in a mouse pneumonia model.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC163489/ - JM Langley and S Halperin; Allergy to antibiotics in children: Perception versus reality.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094872/ - Otitis Media: Diagnosis and Treatment.
https://www.aafp.org/afp/2013/1001/p435.html - Amoxicillin 250mg/5ml Oral Suspension Sugar Free BP.
https://www.medicines.org.uk/emc/medicine/26176#gref - Amoxicillin Monograph – Paediatric.
https://pch.health.wa.gov.au/~/media/Files/Hospitals/PCH/General-documents/Health-professionals/ChAMP-Monographs/Amoxcillin.pdf
Reviewer
Dr. Rajeev Ranjan
(MD)