Amoxicillin (Paediatric)

The dose selected should take into account the expected pathogens and their likely susceptibility, the severity and site of the infection, and the age, weight and renal function of the patient. Duration should be determined by the type of infection and the response, and should generally be as short as possible. FULL ADULT / OVER-40 kg INDICATION TABLE (§4.2): acute bacterial sinusitis, asymptomatic bacteriuria in pregnancy, acute pyelonephritis, and dental abscess with spreading cellulitis — 250 mg to 500 mg every 8 hours or 750 mg to 1 g every 12 hours, and for severe infections 750 mg to 1 g every 8 hours; acute cystitis — may be treated with 3 g twice daily for one day; acute otitis media — 500 mg every 8 hours, or 750 mg to 1 g every 12 hours; acute streptococcal tonsillitis and pharyngitis, and acute exacerbations of chronic bronchitis — for severe infections 750 mg to 1 g every 8 hours for 10 days; community acquired pneumonia — 500 mg to 1 g every 8 hours; typhoid and paratyphoid fever — 500 mg to 2 g every 8 hours; prosthetic joint infections — 500 mg to 1 g every 8 hours; prophylaxis of endocarditis — 2 g orally as a single dose 30 to 60 minutes before the procedure; Helicobacter pylori eradication — 750 mg to 1 g twice daily in combination with a proton pump inhibitor (e.g. omeprazole, lansoprazole) and another antibiotic (e.g. clarithromycin, metronidazole) for 7 days. Consideration should be given to the official treatment guidelines for each indication. ELDERLY: no dose adjustment considered necessary. HEPATIC IMPAIRMENT: dose with caution and monitor hepatic function at regular intervals. PAEDIATRIC DOSING for children weighing under 40 kg is recorded in the paedDose field and must also be checked against a children's formulary.

dosePerKg is left null because the SPC gives RANGES per indication, not a single per-kg figure. Exact SPC §4.2 wording for children weighing under 40 kg: acute bacterial sinusitis, acute otitis media, community acquired pneumonia, acute cystitis, acute pyelonephritis and dental abscess with spreading cellulitis — '20 to 90 mg/kg/day in divided doses'; acute streptococcal tonsillitis and pharyngitis — '40 to 90 mg/kg/day in divided doses'; typhoid and paratyphoid fever — '100 mg/kg/day in three divided doses'. Twice-daily dosing regimens should only be considered when the dose is in the upper range. Consideration should be given to the official treatment guidelines for each indication. RENAL IMPAIRMENT in children under 40 kg: GFR greater than 30 ml/min — no adjustment necessary; GFR 10 to 30 ml/min — 15 mg/kg given twice daily; GFR less than 10 ml/min — 15 mg/kg given as a single daily dose; in the majority of these cases parenteral therapy is preferred. HAEMODIALYSIS, children under 40 kg: 15 mg/kg/day as a single daily dose (maximum 500 mg); one additional dose of 15 mg/kg before haemodialysis, and another 15 mg/kg dose after haemodialysis to restore circulating drug levels. Superficial tooth discolouration has been reported in children; good oral hygiene may help prevent it. Paediatric dosing must be verified against a children's formulary before use.