Written by Hannah Harp
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Small children usually receive appropriate doses of high-dose amoxicillin, while children over 20kg tend to be underdosed, indicating that many physicians are hesitant to prescribe maximum amoxicillin doses.
More bubblegum flavoring, please!
Amoxicillin is the most prescribed pediatric medication. High-dose amoxicillin (80-90 mg/kg/day) is recommended for AOM, pneumonia, and sinusitis to overcome resistance. For larger children, however, S. pneumoniae resistance often exceeds the normal adult dose. This study examines whether amoxicillin dosing in pediatric patients is appropriately adjusted for different age and weight categories. A retrospective chart review analyzed 3,620 pediatric encounters with diagnoses needing high-dose amoxicillin. Linear regression demonstrated a significant negative correlation between weight and dose per kg (p < .001). Children <6 years clustered around 80 mg/kg/day, while those above 60 kg received less than 40 mg/kg/day. Clinicians frequently capped dosing at adult maximums, despite guidelines citing maximum dose of 4g/day. The article compiles data in terms of mg/kg/day dosing, but does not include information about whether the “underdosed” patients were treated successfully or not.
How will this change my practice?
This article gives us a lot to think about for where the limits of weight-based dosing should lie, how body habitus should affect our dosing calculations, and why a small adult and an obese adult would be given the same starting dose of many medications. I’ll wait for more data on effective dosing for older kids before prescribing 50mL of amoxicillin to a patient who hasn’t learned to swallow pills yet. In the meantime, I’ll keep maxing out at the adult dose.
Source
Small Children Receive Large Doses, While Large Children Receive Low Doses of Amoxicillin Per kg. Clin Pediatr (Phila). 2024 Nov 28:99228241299903. doi: 10.1177/00099228241299903. Epub ahead of print. PMID: 39606838
