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Amoxicillin Indications and Dosage
Actinomyces sp.
anthrax †
anthrax prophylaxis †
Bacillus anthracis
Bifidobacterium sp.
Bordetella pertussis
Borrelia burgdorferi
bronchitis
Brucella sp.
cellulitis
cervicitis †
Chlamydia trachomatis †
Clostridium perfringens
Clostridium tetani
Corynebacterium diphtheriae
cystitis
dental abscess (apical) †
dental abscess (periapical) †
dental infection †
dentoalveolar infection †
duodenal ulcer
Eikenella corrodens
endocarditis prophylaxis
Enterococcus faecalis
Erysipelothrix rhusiopathiae
erythema migrans
Escherichia coli
Eubacterium sp.
gastric ulcer †
gonorrhea
Haemophilus influenzae (beta-lactamase negative)
Helicobacter pylori
Lactobacillus sp.
Listeria monocytogenes
lower respiratory tract infections
Lyme disease †
Neisseria gonorrhoeae
Neisseria meningitidis
non-gonococcal urethritis (NGU) †
otitis media
Peptococcus sp.
Peptostreptococcus sp.
periodontitis †
pharyngitis
pneumonia
Prevotella melaninogenica
Propionibacterium sp.
Proteus mirabilis
Salmonella enteritidis
Salmonella sp.
Salmonella typhi
Shigella sp.
sinusitis
skin and skin structure infections
Staphylococcus sp.
Streptococcus agalactiae (group B streptococci)
Streptococcus dysgalactiae
Streptococcus pneumoniae
Streptococcus pyogenes (group A beta-hemolytic streptococci)
Treponema pallidum
upper respiratory tract infections
urinary tract infection (UTI)
Vibrio cholerae
Viridans streptococci
† non-FDA-approved indication
Amoxicillin Indications and Dosage
The following organisms are generally considered susceptible to amoxicillin in vitro: Actinomyces sp.; Bacillus anthracis; Prevotella melaninogenica; Bifidobacterium sp.; Bordetella pertussis; Borrelia burgdorferi; Brucella sp.; Clostridium perfringens; Clostridium tetani; Corynebacterium diphtheriae; Eikenella corrodens; Enterococcus faecalis; Erysipelothrix rhusiopathiae; Escherichia coli; Eubacterium sp.; Haemophilus influenzae (beta-lactamase negative); Helicobacter pylori; Lactobacillus sp.; Listeria monocytogenes; Neisseria meningitidis; Peptococcus sp.; Peptostreptococcus sp.; Propionibacterium sp.; Proteus mirabilis; Salmonella enteritidis; Salmonella sp.; Salmonella typhi; Shigella sp.; Staphylococcus sp. (beta-lactamase negative and methicillin/oxacillin sensitive only); Streptococcus agalactiae (group B streptococci); Streptococcus dysgalactiae; Streptococcus pneumoniae; Streptococcus pyogenes (group A beta-hemolytic streptococci); Treponema pallidum; Vibrio cholerae; Viridans streptococci.
For the treatment of upper respiratory tract infections (e.g., sinusitis, pharyngitis):
- for mild to moderate infections caused by highly susceptible organisms:
Oral dosage:
Adults, adolescents, and children (weight >= 40 kg): 500 mg PO every 12 hours or 250 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 20 mg/kg/day PO given in equally divided doses every 8 hours or 25 mg/kg/day PO in equally divided doses given every 12 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
- for severe infections or infections caused by less susceptible organisms:
Oral dosage:
Adults, adolescents, and children (weight >= 40 kg): 875 mg PO every 12 hours or 500 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 40 mg/kg/day PO in equally divided doses every 8 hours or 45 mg/kg/day PO in equally divided doses every 12 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
For the treatment of acute otitis media:
NOTE: In children who have received antibiotics during the prior month, there is an increased risk of infection with penicillin-intermediate † or -resistant † S. pneumoniae, as well as ?-lactamase-producing strains of H. influenzae and M. catarrhalis; initial treatment with high-dose amoxicillin/clavulanate should be considered.
- for mild to moderate infections caused by highly susceptible organisms:
Oral dosage:
Adults and children (weight >= 40 kg): 500 mg PO every 12 hours or 250 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 80 - 90 mg/kg/day PO administered in equally divided doses every 8 or 12 hours for 10 days is recommended by experts as first-line therapy. The manufacturers recommended dose is 20 mg/kg/day PO given in equally divided doses every 8 hours or 25 mg/kg/day PO in equally divided doses given every 12 hours.
Infants and neonates <= 3 months: The manufacturer recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
- for severe infections or infections caused by less susceptible organisms:
Oral dosage:
Adults and children (weight >= 40 kg): 875 mg PO every 12 hours or 500 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 80 - 90 mg/kg/day PO administered in equally divided doses every 8 or 12 hours for 10 days is recommended by experts as first-line therapy. The manufacturers recommended dose is 40 mg/kg/day PO in equally divided doses every 8 hours or 45 mg/kg/day PO in equally divided doses every 12 hours.
Infants and neonates <= 3 months: The manufacturer recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
For the treatment of skin and skin structure infections (e.g., cellulitis):
- for mild to moderate infections caused by highly susceptible organisms:
Oral dosage:
Adults, adolescents, and children (weight >= 40 kg): 500 mg PO every 12 hours or 250 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 20 mg/kg/day PO given in equally divided doses every 8 hours or 25 mg/kg/day PO in equally divided doses given every 12 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
- for severe infections or infections caused by less susceptible organisms:
Oral dosage:
Adults, adolescents, and children (weight >= 40 kg): 875 mg PO every 12 hours or 500 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 40 mg/kg/day PO in equally divided doses every 8 hours or 45 mg/kg/day PO in equally divided doses every 12 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
For the treatment of lower respiratory tract infections (e.g., bronchitis) due to susceptible organisms:
Oral dosage:
Adults and children (weight >= 40 kg): 875 mg PO every 12 hour or 500 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 45 mg/kg/day PO in equally divided doses every 12 hour or 40 mg/kg/day PO in equally divided doses every 8 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
For the treatment of community-acquired pneumonia (CAP) due to susceptible organisms:
- for the treatment of CAP in children as outpatients:
Oral dosage:
Children >= 5 years: A macrolide is considered first-line therapy in this age group. However, if child has pneumococcal infection, amoxicillin 90 mg/kg/day PO in equally divided doses every 8 hours alone is recommended.
Children and infants 4 months to 59 months: 90 mg/kg/day PO in equally divided doses every 8 hours.
- for the treatment of CAP in previously healthy adult outpatients and outpatients with comorbidities (e.g., COPD, diabetes, renal failure, etc.) who received antibiotics within last 3 months:
Oral dosage:
Adults: 1 g PO three times daily in combination with azithromycin or clarithromycin.
- for the treatment of CAP in adult outpatients with influenza with bacterial superinfection:
Oral dosage:
Adults: 1 g PO three times daily.
For the treatment of urinary tract infection (UTI) including cystitis:
- for mild to moderate infections caused by highly susceptible organisms:
Oral dosage:
Adults, adolescents, and children (weight >= 40 kg): 500 mg PO every 12 hours or 250 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 20 mg/kg/day PO given in equally divided doses every 8 hours or 25 mg/kg/day PO in equally divided doses given every 12 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
- for severe infections or infections caused by less susceptible organisms:
Oral dosage:
Adults, adolescents, and children (weight >= 40 kg): 875 mg PO every 12 hours or 500 mg PO every 8 hours.
Children and infants > 3 months (weight < 40 kg): 40 mg/kg/day PO in equally divided doses every 8 hours or 45 mg/kg/day PO in equally divided doses every 12 hours.
Neonates and infants <= 3 months: The recommended maximum dosage is 30 mg/kg/day PO given in divided doses every 12 hours.
For the treatment of uncomplicated gonorrhea due to Neisseria gonorrhoeae when the infecting strain has been tested and found to be susceptible to penicillin:
NOTE: Amoxicillin is not included in current CDC recommendations for the treatment of gonorrhea due to the high prevalence of amoxicillin-resistant strains of N. gonorrhoeae, however, the manufacturer’s product literature still offers the following dosages:
Oral dosage:
Adults and children (weight >= 40 kg): 3 g PO as a single dose with 1 g PO of probenecid.
Children >= 2 years (weight < 40 kg): 50 mg/kg PO as a single dose with 25 mg/kg PO of probenecid. Maximum daily dose in children for amoxicillin is 3 g and for probenecid is 1 g.
Children < 2 years: Because probenecid is contraindicated in this age group, the regimen of amoxicillin plus probenecid is also contraindicated.
For the treatment of Lyme disease † :
- for the treatment of early-stage Lyme disease as an alternative to tetracycline or penicillin V in children < 9 years of age or as an alternative to tetracycline in pregnant or lactating women:
Oral dosage:
Adults: Doses of 250 - 500 mg PO three times per day for 10 - 30 days have been used.
Children: 20 - 50 mg/kg/day PO in divided doses every 8 hours for 10 - 30 days. Maximum 1 - 2 g per day.
- for the treatment of patients with erythema migrans:
Oral dosage:
Adults: A double-blind, randomized trial compared amoxicillin (without probenecid) with azithromycin in patients with erythema migrans. Those treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution by day 20, the end of the study. Significantly more azithromycin recipients relapsed than amoxicillin recipients. The dose of amoxicillin in this study was 500 mg PO three times per day for 20 days.
- for the treatment of Lyme arthritis:
Oral dosage - in combination with probenecid:
Adults: 500 mg PO four times per day with probenecid for 30 days.
For the treatment of pregnant women with non-gonococcal urethritis (NGU) † or cervicitis † caused by Chlamydia trachomatis † :
Oral dosage:
Adults and adolescents: The CDC recommends 500 mg PO three times per day for 7 days.
For the treatment of dental infection † , including dentoalveolar infection † :
- for the treatment of adolescent aggressive periodontitis † or adult refractory chronic periodontitis † in combination with metronidazole after scaling and root planing:
Oral dosage:
Adults and adolescents >= 16 years: Amoxicillin 250 - 375 mg PO three times daily with metronidazole (250 mg PO three times daily) for 7 - 10 days.
- for the treatment of acute dental abscess (apical) † and/or dental abscess (periapical) † in combination with surgical incision and drainage:
Oral dosage:
Adults: 1 g PO as a loading dose followed by 500 mg PO three times daily for 3 days.
For bacterial endocarditis prophylaxis:
- for prophylaxis in patients at risk who are undergoing dental, oral, respiratory tract, esophageal, or gastrointestinal/genitourinary procedures including those who are at moderate risk (i.e., prosthetic valves or previous endocarditis):
Oral dosage:
Adults: 2 g PO as a single dose administered 1 hour before procedure.
Children: 50 mg/kg PO as a single dose administered 1 hour before procedure. The total children’s dose should not exceed the adult dose of 2 g PO.
- for prophylaxis in high-risk patients who underwent genitourinary/gastrointestinal procedures and received IV ampicillin plus gentamicin prior to the procedure:
Oral dosage:
Adults: Give amoxicillin 1 g PO as a single dose administered 6 hours following ampicillin/gentamicin.
Children: Give amoxicillin 25 mg/kg PO as a single dose administered 6 hours following ampicillin/gentamicin.
For the treatment of salmonella infection † due to Salmonella enteritidis or Salmonella typhi in patients with AIDS:
Oral dosage:
Adults: 1 g PO three times per day for 3 - 14 days.
For the treatment of duodenal ulcer or gastric ulcer † associated with Helicobacter pylori infection in non-penicillin allergic patients:
NOTE: Triple-drug regimens given for two weeks are recommended by the American College of Gastroenterology; the highest H. pylori eradication rates are achieved by triple-drug regimens that include a proton pump inhibitor (PPI) or ranitidine bismuth citrate. While some dual-drug regimens are FDA-approved, they do not obtain the same eradication rates achieved by the 3-drug regimens (>= 90%).
NOTE: Metronidazole resistance to H. pylori is increasing (e.g., 54%) in the US; whereas amoxicilin resistance is rare. Resistance rates for H. pylori to clarithromycin in the US are 7 - 11%. Triple combination regimens containing a proton pump inhibitor (PPI), clarithromycin, and either amoxicillin or metronidazole are recommended by the American Society of Gastroenterology.
Oral dosage:
Adults: The FDA-approved regimen consists of amoxicillin 1000 mg PO twice daily in combination with clarithromycin (500 mg PO twice daily) and lansoprazole (30 mg PO twice daily) for 10 - 14 days. When used for 2 weeks, this is one of several triple drug regimens recommended by the ACG guidelines for managing H. pylori infection. This regimen is associated with a high eradication rate and less side effects than regimens which include metronidazole.
- in combination with clarithromycin and omeprazole:
Oral dosage:
Adults: The FDA-approved dosage includes amoxicillin 1000 mg PO twice daily in combination with clarithromycin (500 mg PO twice daily) and omeprazole (40 mg/day PO) for 10 days. The ACG recommends the same triple-drug dosage regimen, but suggests a longer duration of therapy (14 days) to ensure the highest H. pylori eradication rates, until further data are available.
Children † : Amoxicillin 50 mg/kg/day PO (maximum 1 g PO twice daily), given as part of a triple drug regimen with a proton pump inhibitor (PPI) and one other antimicrobial agent effective against Helicobacter pylori. First-line regimens recommended by The North American Society for Pediatric Gastroenterology and Nutrition include 1 - 2 weeks of proton pump inhibititor (PPI) therapy (e.g., omeprazole 1 mg/kg/day PO; maximum 20 mg PO twice daily) given in combination with two of the following antibiotics: amoxicillin (25 mg/kg twice daily PO up to 1 g PO twice daily), clarithromycin (7.5 mg/kg twice daily PO up to 500 mg twice daily), or metronidazole (20 mg/kg/day PO up to 500 mg PO twice daily). A second-line option (quadruple regimen) includes the addition of bismuth subsalicylate. In the first randomized, double-blind study conducted in children (N=73) with H. pylori gastrointestinal infection (gastritis), a 1-week triple regimen of omeprazole, amoxicillin (dosage 25 mg/kg PO twice daily), and clarithromycin (OAC) was compared to dual therapy with amoxicillin and clarithromycin (AC). The eradication rate was 74.5% in the OAC group, significantly higher than in the AC group (9.4%). These eradication rates were slightly lower than the recommended cure rate (>= 80%) for H. pylori eradication in adults. The resistance of strains to clarithromycin was 7.7%, and was not associated with failure of treatment. The urea breath test was used to evaluate the eradication rate in this study ; this test has been associated with false positive results in young children. Further controlled studies are needed to define the optimal dosage and duration of H. pylori therapy in children, as well as the ideal method of evaluating H. pylori eradication.
- in combination with metronidazole and omeprazole † :
Oral dosage:
Children † : Amoxicillin 50 mg/kg/day PO (maximum 1 g PO twice daily), given as part of a triple drug regimen with a proton pump inhibitor (PPI) and one other antimicrobial agent effective against Helicobacter pylori. First-line regimens recommended by The North American Society for Pediatric Gastroenterology and Nutrition include 1 - 2 weeks of proton pump inhibititor (PPI) therapy (e.g., omeprazole 1 mg/kg/day PO; maximum 20 mg PO twice daily), given in combination with two of the following antibiotics: amoxicillin (50 mg/kg/day PO up to 1 g PO twice daily), clarithromycin (15 mg/kg/day PO up to 500 mg twice daily), or metronidazole (20 mg/kg/day PO up to 500 mg PO twice daily). A second-line option (quadruple regimen) includes the addition of bismuth subsalicylate to this regimen.
- in combination with levofloxacin and rabeprazole † :
Oral dosage:
Adults: A prospective, open label study evaluated the effectiveness of levofloxacin-based dual (levofloxacin/rabeprazole) and triple (levofloxacin/amoxicillin/rabeprazole) therapy in eradicating H. pylori. Patients (n=160) were randomized into 4 groups (3 dual and 1 triple therapy regimen). The dual regimens consisted of levofloxacin 500 mg PO once daily with rabeprazole (20 mg PO once daily) for 5, 7, or 10 days. The triple regimen included amoxicillin 1000 mg PO twice daily, levofloxacin (500 mg PO once daily), and rabeprazole (20 mg PO once daily) for 7 days. Triple therapy resulted in a significantly higher eradication rate (> 90%) than dual therapy at any duration (<= 70%).
For third-line treatment of cutaneous anthrax † infection due to exposure to Bacillus anthracis as an alternative to ciprofloxacin or doxycycline, if antibiotic susceptibility testing allows:
NOTE: In the setting where high concentrations of B. anthracis organisms are present, the treatment of infections with a penicillin-type drug alone is a concern due to the risk of a beta-lactamase induction event, which would significantly increase the MIC.
Oral dosage:
Adults, adolescents, pregnant females, and children >= 20 kg: Amoxicillin 500 mg PO every 8 hours for a total of 60 days could be substituted for ciprofloxacin.
Children < 20 kg: Amoxicillin 80 mg/kg PO divided into 3 doses given every 8 hours for a total of 60 days could be substituted for ciprofloxacin.
For anthrax prophylaxis † as an alternative to ciprofloxacin or doxycycline following exposure to Bacillus anthracis regardless of the route of exposure, if antibiotic susceptibility testing allows:
NOTE: The CDC states that amoxicillin is suitable for postexposure prophylaxis only after 10 - 14 days of fluoroquinolones or doxycycline treatment and then only if there are contraindications to these two classes of antibiotics (e.g., intolerance, pregnancy, age < 18 yrs).
Oral dosage:
Adults, adolescents, pregnant females, and children >= 20 kg: Amoxicillin 500 mg PO every 8 hours for a total of 60 days.
Children < 20 kg: Amoxicillin 40 mg/kg PO divided into 3 doses given every 8 hours for a total of 60 days.
Maximum Dosage Limits:
Adults: 1750 mg/day PO.
Elderly: 1750 mg/day PO.
Adolescents: 1750 mg/day PO.
Children (weight >= 40 kg): 1750 mg/day PO.
Children (weight < 40 kg): 40 mg/kg/day PO for most indications. To increase the efficacy of amoxicillin against penicillin-resistant S. pneumoniae, up to 90 mg/kg/day PO has been used.
Infants > 3 months: 40 mg/kg/day PO for most indications. To increase the efficacy of amoxicillin against penicillin-resistant S. pneumoniae, up to 90 mg/kg/day PO has been used.
Infants <= 3 months: 30 mg/kg/day PO.
Neonates: 30 mg/kg/day PO.
Patients with hepatic impairment:
No dosage adjustment needed; amoxicillin is not appreciably metabolized in the liver and does not undergo biliary secretion.
Patients with renal impairment:
The following dosing recommendations pertain to adults. No specific dosage adjustments for pediatric patients with renal impairment are available at this time; however, dosages should be adjusted.
CrCl > 30 ml/min: no dosage adjustment needed.
CrCl 10 - 30 ml/min: 250 - 500 mg PO every 12 hours, depending on the severity of the infection. Do not use the 875 mg-tablet strength for dosing.
CrCl < 10 ml/min: 250 - 500 mg PO every 24 hours, depending on the severity of the infection. Do not use the 875 mg-tablet strength for dosing.
Intermittent hemodialysis:
For adults, 250 - 500 mg PO every 24 hours, depending on the severity of the infection. According to the manufacturer, an additional dose should be given both during and at the end of a dialysis session. Do not use the 875 mg-tablet strength for dosing.
Peritoneal dialysis:
Follow dosage recommendations as for renal impairment for CrCl < 10 ml/min for those patients receiving continuous ambulatory peritoneal dialysis (CAPD). Do not use the 875 mg-tablet strength for dosing.
† non-FDA-approved indication
[ Last revised: 3/1/2006 9:36:00 AM ]
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. Luft BJ, Dattwyler RJ, Johnson RC et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans. Ann Intern Med 1996;124;785 - 91.
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. Inglesby TV, O’Toole T, Henderson DA, et al. Anthrax as a biological weapon, 2002: Updated recommendations for management. JAMA 2002;287;2236 - 52.
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. Gottrand F, Kalach N, Spyckerelle C, et al. Omeprazole combined with amoxicillin and clarithromycin in the eradication of Helicobacter pylori in children with gastritis: A prospective randomized double-blind trial. J Pediatr 2001;139:664 - 8.
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