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Amoxicillin for children with pneumonia

Lower dosage and shorter duration?


Amoxicillin is the drug of first choice to treat community-acquired pneumonia (CAP) in children below 5 years of age. There is, however, no consensus about the dosage or the duration of the course of treatment. Dutch guidelines recommend a daily oral dosage of amoxicillin of 40 to 50 mg/kg, divided over three doses a day, for 5 days. A non-inferiority study has shown that treatment with a low dosage (35 to 50 mg/kg/day in two doses) is just as effective as treatment with a high dosage (70 to 90 mg/kg/day in two doses), and that a 3-day course of treatment is just as effective as a 7-day course. Reducing the overall use of antibiotics is important to prevent resistance and bacterial superinfections, and can result in fewer adverse effects, greater compliance and lower costs. 

  • Treating children with CAP under the age of 5 years with a low dosage of amoxicillin (35 to 50 mg/kg/day in two doses) is non-inferior to treatment with a high dosage (70 to 90 mg/kg/day in two doses) for 3 to 7 days.
  • A 3-day course of amoxicillin treatment (using low or high dosage) is non-inferior to a 7-day course (using low or high dosage).
  • The duration currently recommended in the Netherlands for the treatment of childhood CAP with amoxicillin at 40 to 50 mg/kg per day could perhaps be reduced even further, from 5 to 3 days. 
  • Adjustment of the duration of treatment should first be confirmed in research that includes the dosing frequency, the severity of the pneumonia and any comorbidity.

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Authors

  • Erik P. Schwarz