Amoxicillin Dosage for Children – Side Effects and Precautions

Amoxicillin is a narrow spectrum Penicillin-based antibiotic used for treating bacterial infections. Certified by the World Health Organisation (WHO) as a very safe drug for children, it treats respiratory infections like whooping cough, sinusitis, bronchitis, pneumonia, and throat and middle ear infections. Based on the culture results, some skin and urinary tract infections (UTIs) are also treated with this antibiotic. Alongside its benefits, parents need to be aware of potential side effects and necessary precautions when giving amoxicillin to children. In this article, we will tell you about the correct amoxicillin dose for kids, possible side effects, and precautions required to consider to optimise the therapeutic benefits of amoxicillin while minimising risks for children.

What Is Amoxicillin?

Amoxicillin is derived from Penicillin, the oldest known antibiotic. It is a better version of its predecessor in its ability to tackle a much larger variety of bacterial strains and its improved ability to get absorbed into the bloodstream. Sold under different brand names, this generic drug is widely used to treat gram-negative and gram-positive bacterial infections in the ear, throat, and upper respiratory system.

Amoxicillin and potassium clavulanate are widely used with enhanced absorption characteristics. The clavulanate additive prevents bacterial cell wall formation, broadening the spectrum of bacteria that can be countered with amoxicillin.

When Do Doctors Prescribe Amoxicillin to Children?

Amoxicillin is an antibacterial drug used to treat specific strains of bacteria. Contrary to popular belief, this drug does not work against viral infections such as flu and the common cold simply because of its targeted mechanism of action against the bacterial cell wall. Some common ear, nose, and throat (ENT) system infections are effectively treated with amoxicillin. Here is a list of conditions doctors usually prescribe amoxicillin for children.

• Acute otitis media, a common type of middle ear infection in children (10)
• Respiratory infections like sinusitis, bronchitis, pneumonia
• A whooping cough
• Throat infections like ‘strep throat’ caused by the streptococcal strain of bacteria
• Tonsillitis
• Some skin infections
• Urinary tract infections
• Acute malnutrition in children (2)

Many parents tend to self-medicate kids with amoxicillin when their child suffers from these conditions recurrently. However, it is a hazardous and unhealthy practice to administer antibiotics without consulting a doctor, as the dosage and combination may be specific to specific cases. This leads to improper treatment and paves the way for developing amoxicillin-resistant bacterial strains in the body.

How to Use Amoxicillin?

The generic antibacterial drug called amoxicillin is available under different brand names. It is also available in combination with some chemicals for enhanced action. This medication is very effective, and when prescribed to children, they usually get better within two to three days of drug intake. The drug is available in the following forms.

• Oral suspension: Oral suspension is particularly suitable for children. The antibiotic is a powder that can be reconstituted in water or milk. It is usually flavoured to enhance its colour and taste. The cleanliness of the diluting ingredients is essential. Usually, a dosing syringe or a measuring cup is used for accurate dilution.
• Paediatric Drops: Paediatric drops are readymade diluted syrups of the desired concentration. They are usually given to small children, with significantly less dosage, and the drug is administered as drops. Paediatric drops come in a bubble gum flavour.
• Capsules: Capsules of amoxicillin are also available with varying doses. They are given to slightly grownup children and usually taken with water, milk or juice.
• Regular Tablets: Amoxicillin is sold as oral tablets with immediate-release (IR) and extended-release (ER) options. The immediate-release tablets are generic drugs only. The immediate-release and extended-release tablets differ in their respective drug absorption rates, and the doctor prescribes the preferred version depending on the patient’s condition.
• Extended-release Tablets: These tablets are believed to be more effective as they have sustained and elevated doses over long periods.
• Chewable Tablets: Mildly flavoured chewable tablets are available in the market, making it easier for children to consume this drug.

The amoxicillin drug in any of the above forms has to be stored in a cool and dry place, away from direct sun, and out of reach of children.

Drugs You Should Avoid Using With Amoxicillin

If the doctor prescribes amoxicillin to your child and your child is already on another medication, you must inform your child’s doctor about the same. There are certain drugs which, when taken along with amoxicillin, may have some unwanted and adverse reactions by way of increased or decreased efficacy of the other drug. The ability of the body to collectively excrete the drugs also matters when deciding treatment options. Some of the medicines that should be avoided are:

• Allopurinols (3)
• Doxycycline
• Live cholera vaccine
• Lymecycline
• Meclocycline
• Methotrexate, widely used to treat cancer
• Minocycline
• Other anti-bacterial medicines like macrolides, chloramphenicol, tetracycline and sulphonamides
• Probenecid
• Venlafaxine
• Warfarin

Some parents also give their children vitamin supplements or herbal medication for other conditions. The doctor should be informed about this. Although there is no known evidence of an interaction of amoxicillin with vitamins and herbs, it is best to keep the doctor informed.

It is also critical to communicate to the doctor about any known history of allergy to amoxicillin or penicillin before starting the treatment. If the child is suffering from kidney disease, asthma, or hay fever, the child’s doctor should be aware of it, as this information will be critical in deciding the course of treatment.

Amoxicillin Dosage for Kids According to Weight/Age

Children’s dose of amoxicillin is very different from that of the adults. Typically, the dosage is determined considering the child’s age, weight, and the degree and nature of the infection. Here’s the amoxicillin dosage chart by weight for children. This chart gives a general guideline for determining the amoxicillin dosage.

A fair idea about the permissible dosage is essential to avoid giving an overdose to the child. The numbers mentioned above are a general guide to the drug concentrations. The dosage prescribed by the doctor for the specific cases has to be followed diligently.

What If You Fail to Give a Dose to Your Child?

If a dose of amoxicillin is missed, it can be given immediately, provided there is a considerable gap before the next dose. If the time is up for the next dose, then there is no requirement to give a double dosage (4).

What If Your Child Vomits?

Vomiting is a common side effect of amoxicillin in children. Since the drug alters the gut microflora, it can cause vomiting. Make sure that the kid is taking enough fluids and electrolytes. Usually, consuming food along with the medication helps to control vomiting. Probiotics also help restore the good bacteria in the stomach.

What If You Give an Overdose?

An overdose of the antibiotic may cause intense side effects in children. Depending upon the magnitude of the overdose, children may experience severe rashes, kidney damage, nausea, and less urination, along with many other symptoms. In such cases, immediate medical treatment is mandatory.

How to Treat Overdose?

There is no particular antidote for an amoxicillin overdose in children. Multiple doses of activated charcoal remove the excess amoxicillin from the body. Activated charcoal immediately interrupts the circulation of the antibiotic. Sometimes, doctors wash the stomach to flush out the medicine. Treatment is also given to correct the symptoms arising out of the overdose. Haemodialysis is done if the condition is severe.

Side Effects of Amoxicillin in Kids

Knowing the amoxicillin side effects in children is essential for parents to ensure safe and effective treatment. Although considered a very safe drug, amoxicillin may cause some mild side effects in children.

• Stomach discomfort with nausea and mild to severe diarrhoea: This common side effect occurs due to changes in the gut flora caused by the antibiotic. If diarrhoea results in considerable loss of body fluids, it is advisable to consult a medical practitioner immediately (1).
• Patches around the mouth, throat and vagina (in girls) (8)
• Sudden swelling of the throat and tongue coupled with difficulty in breathing: This is categorised as ‘anaphylaxis’ or a severe allergic reaction which requires immediate medical attention (6).
• Hives or itchy red patches on the skin (9)
• Loss of appetite (7)
• Tiredness or weakness after taking a dosage of the drug
• General fatigue
• Heavy periods in girls
• Paleness of the skin
• Taste aversion
• Unusual bleeding
• Burning sensation while urinating

Usually, the side effects subside in a day or two as the child’s body gets acclimatised to the drug, but it is better to keep the doctor informed about any new allergic reaction.

Safety Measures While Taking Amoxicillin

While administering amoxicillin, it is better to consult the doctor and get an opinion on the other allowed medications. Vomiting and diarrhoea are common side effects of antibiotic intake. Do not give medication to stop watery stools without consulting with the doctor.

Also, when a child is treated with amoxicillin, the urine sugar levels may show some false positives. In such cases, other methods of measuring sugar levels can be adopted.

Important Things to Remember About Antibiotics

Some essential things that you should remember while taking antibiotics or giving them to your child are mentioned below:

• Strictly follow the dosage and timelines prescribed by the doctor. Increasing or decreasing the dosage can delay the recovery process.
• Complete the course of antibiotics given for an infection. Stopping the medication in between can lead to developing resistant strains of bacteria.
• Watch out for any adverse reactions or side effects, especially in children.
• Avoid any allergic food substances and medicines proven to interfere with antibiotics.
• Antibiotics are only effective against bacterial infections, not viral illnesses like the common cold or flu (11). Using antibiotics unnecessarily contributes to antibiotic resistance and should be avoided.
• Antibiotics prescribed for one person may not be suitable for another, even if they have similar symptoms. Avoid sharing antibiotics with others or saving leftover antibiotics for future use (12).
• If your child has experienced allergic reactions to antibiotics, inform your healthcare provider before starting a new antibiotic.
• Store antibiotics as directed on the label or by your pharmacist.

FAQs

1. Are there any severe side effects of amoxicillin in children?

In rare cases, amoxicillin can cause serious side effects such as severe allergic reactions (anaphylaxis), liver damage, and Clostridium difficile-associated diarrhoea (CDAD) (5). Parents should seek medical attention if their child experiences severe or persistent side effects.

2. Can amoxicillin be given to infants and newborns?

Amoxicillin can be prescribed to infants and newborns for certain bacterial infections. However, a paediatrician should carefully determine the dosage and administration based on the infant’s weight, age, and medical condition.

3. Can children be allergic to amoxicillin? How can parents recognise an allergic reaction?

Yes, children can be allergic to amoxicillin. Symptoms of an allergic reaction may include rash, itching, swelling, difficulty breathing, or severe dizziness. Seek medical help immediately if any of these symptoms occur.

4. Is it safe to give leftover amoxicillin to children?

No, it is not safe to give leftover amoxicillin to children. Expired antibiotics may be ineffective or contaminated, and giving the wrong dosage can lead to antibiotic resistance or adverse reactions. It’s crucial to remember that unused medications should be properly disposed of according to local regulations, ensuring you’re taking the right steps for your child’s health.

Amoxicillin is a safe and effective treatment option for bacterial infections in kids. If your child’s doctor prescribes this drug, give it to your child in the proper dosage and at the right time. Remember the above pointers to ensure your child recovers completely and feels better soon!

References/Resources:

1. Amoxicillin; Healthify He Puna Waiora; https://healthify.nz/medicines-a-z/a/amoxicillin/

2. Amoxicillin for Acute Malnutrition in Children; The New England Journal of Medicine; https://www.nejm.org/do/10.1056/NEJMdo005050/full/; February 2016

3. Amoxicillin; C.S. Mott Children’s Hospital; https://www.mottchildren.org/health-library/d00088a1

4. Lansoprazole, Clarithromycin, and Amoxicillin; MedlinePlus; https://medlineplus.gov/druginfo/meds/a601067.html

5. Amoxicillin Monograph – Paediatric; Perth Children’s Hospital; https://pch.health.wa.gov.au/~/media/Files/Hospitals/PCH/General-documents/Health-professionals/ChAMP-Monographs/Amoxcillin.pdf

6. Langley. J, Halperin. S; Allergy to antibiotics in children: Perception versus reality; PubMed Central; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094872/

7. Amoxicillin; St. Jude Children’s Research Hospital; https://www.stjude.org/treatment/patient-resources/caregiver-resources/medicines/a-z-list-of-medicines/amoxicillin.html

8. Amoxicillin for bacterial infections; Medicines for Children; https://www.medicinesforchildren.org.uk/medicines/amoxicillin-for-bacterial-infections/#urgent-side-effects

9. Amoxicillin; Memorial Sloan Kettering Cancer Center; https://www.mskcc.org/cancer-care/patient-education/medications/pediatric/amoxicillin

10. Amoxicillin; NHS; https://www.nhs.uk/medicines/amoxicillin/

11. Antibiotic Do’s & Don’ts; Centers for Disease Control and Prevention; https://www.cdc.gov/antibiotic-use/do-and-dont.html

12. Antibiotics; Johns Hopkins University; https://www.hopkinsmedicine.org/health/wellness-and-prevention/antibiotics

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Zinc for Children
Ibuprofen for Kids
Cod Liver Oil for Kids
Paracetamol Dosage for Children

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