Amoxicillin for kids: formulations, dose & side effects

Amoxicillin is one of the most prescribed antibiotics in the UK. In this post, I will review all the essential information about the use of amoxicillin in children. ‘Amoxicillin for kids’ – the outline of the post: 

• Forms of amoxicillin for kids
• Indicated use of amoxicillin 
• Dosage of amoxicillin in children 
• Possible side effects 
• Storage and expiry dates 

Amoxicillin for kids: legal status

Amoxicillin is a prescription-only medication (POM). The supply of POM medicines requires a prescription written by a GP or another authorised healthcare professional. 

Forms of amoxicillin for kids

All forms of amoxicillin antibiotic used in children come in as powder for oral suspension. When a prescription is brought to the pharmacy, a member of a pharmacy team mixes the powder with water to make a suspension. 

Occasionally amoxicillin powder is given to patients/parents to mix at home when needed as requested by the prescriber or parents themselves. It is essential to follow the directions for the reconstitution, which are located on the bottle when mixing the powder with water. The amount of water needed to prepare amoxicillin suspension may be different between various preparations of amoxicillin. Mixing of the antibiotic with the incorrect amount of water will lead to incorrect dose of the medication given to the patient.  

Most (but not all) of amoxicillin preparations for children have a shelf life of 7 days when mixed with water. Patients may be given one bottle of already mixed amoxicillin suspension and an owing for another bottle (to collect at a different time) when the treatment duration is longer than 7 days. Part supply is given to ensure that both bottlers of the antibiotic do not go out of date after the 7th day of the treatment. Patients may request to take the second bottle away with them to mix at home. 

Different strengths of amoxicillin for kids exist: 

• Amoxicillin 125mg/5ml Oral Suspension
• Amoxicillin 125mg/5ml Oral Suspension sugar-free
• Amoxicillin 250mg/5ml Oral Suspension 
• Amoxicillin 250mg/5ml Oral Suspension sugar-free

Amoxicillin is also available in combination with clavulanic acid known as co-amoxiclav, which is available in a generic form and branded as Augmentin: 

• Co-amoxiclav 125 mg/31.25mg/5 ml Powder for Oral Suspension
• Co-amoxiclav 250 mg/62.5 mg/5 ml Powder for Oral Suspension
• Co-amoxiclav 400 mg/57mg/5ml Powder for Oral Suspension

or

• Augmentin 125/31 Suspension
• Augmentin 250/62 Suspension

What flavour does amoxicillin for kids come in? 

From time to time, parents ask if a specific formulation of amoxicillin suspension comes in a particular flavour. It is not possible to choose the flavour of a prescribed antibiotic. Typical flavours of amoxicillin oral suspension include: 

• Orange 
• Lemon 
• Fruity 
• Banana 

The above list of flavours come from all formulations of amoxicillin suspension rather than one formulation. If information is needed on the flavour, speak to the pharmacy team, before amoxicillin powder is reconstituted. Information on the flavour of liquid antibiotics is usually provided inside the information leaflet. Pharmacies may store more than one version of amoxicillin, which may be of the same or different flavour. 

Can you mix amoxicillin for kids with other liquids e.g., milk to ease the administration? 

The above question is a popular question that parents ask in the pharmacy. Many formulations of antibiotics are unpleasant in taste, despite its artificial flavours. 

None of the product information for amoxicillin suspension advises on whether it is ok to mix an antibiotic with other liquids such as milk or juices. One needs to think about the possible effect of juice or milk on the absorption of the drug (how much drug into the body) as well as the impact on the dosing of the antibiotic. Is the child going to take the full dose when antibiotic is mixed with another liquid? 

Although many websites advise patients to speak to the pharmacist about mixing of the antibiotic with other liquids, it is unlikely they will have a definite answer. Speaking to a GP may be a better choice. Although most likely they will not know whether it is ok to mix liquid antibiotics for children with other liquids, they can give directions for the administration of medicines, even when they are not according to the product license (unlicensed use of medication). 

What is amoxicillin for kids used for? 

Amoxicillin is a broad-spectrum antibiotic used in the treatment of infections caused by a wide range of bacteria, including (non-exclusive list): 

• Bacterial sinusitis 
• An infection of the middle ear (otitis media) 
• Tonsillitis with a bacterial infection 
• Community-acquired pneumonia
• Cystitis 
• Dental infections 

Amoxicillin for children: recommended doses

Please follow the instructions from your GP for dosage instructions. Check the dispensing label for dosage instructions. Dosage may be different and may depend on the severity of the infections and the type of infection treated.  

Amoxicillin is usually taken three times a day (every eight hours). 

The following doses are the recommended doses in the treatment of infections such as oral infections, sinusitis, or ear infection (NICE, 2020): 

For Neonate 7 days to 28 days

The dose of amoxicillin is based on the weight of the baby: 

30mg/kg 3 times a day (max. per dose 125 mg).

For Child 1–11 months

125mg 3 times a day; increased if needed up to 30 mg/kg 3 times a day.

For Child 1–4 years

250mg 3 times a day; increased if needed up to 30 mg/kg 3 times a day.

For Child 5–11 years

500mg 3 times a day; increased if needed up to 30 mg/kg 3 times a day (max. per dose 1 g).

For Child 12–17 years

500mg 3 times a day; increased if needed up to 1g, taken 3 times a day. The increased dose is used in severe infections.

The above doses are given in milligrams (mg) of amoxicillin. When prescribed, the treatment dose is usually given in milliliters (mL) of the antibiotic. For example, the following is prescribed for a 6-month baby: 

Amoxicillin 125mg/5ml Oral Suspension

Dosage: Take 5mL three times a day for 5 days

The above dose equals to 125mg of amoxicillin taken three times a day. 

Amoxicillin capsules

Amoxicillin for adults and adolescents is also available in the form of capsules. Each capsule contains 500mg of amoxicillin. Amoxicillin capsules are also available as 250mg capsules. 

How is long amoxicillin taken for? 

Duration of treatment with amoxicillin is usually 5, 7, or 14 days; however, longer treatment may be necessary depending on the type of infection treated. Follow the GP’s directions and always complete the course of antibiotics, even if the symptoms are resolved.  

Amoxicillin for kids: possible side effects

The use of amoxicillin is associated with potential side effects. Common side effects may include: 

• Diarrhoea
• Nausea
• Skin rash 

Very rarely, amoxicillin can cause severe allergic reactions and anaphylaxis. 

Storage and expiry dates

Storage of liquid antibiotics for children was discussed in another post – Antibiotics for children: refrigeration and expiry dates. 

Storage of amoxicillin for children

Once mixed with water, all forms of amoxicillin suspension need to be refrigerated (2°C-8°C). 

Once made up, the amoxicillin solution usually has 7 days shelf life. However, some sugar-free versions of amoxicillin solution for children have a shelf life of 14 days. Please check for expiry dates on the bottle of the product or dispensing label.

Co-amoxiclav storage and expiry times

Once made up into oral suspension, co-amoxiclav needs to be refrigerated at 2°C – 8°C.

Once mixed with water, co-amoxiclav has an expiry time of 7 days.

Augmentin, a branded co-amoxiclav solution, has 7 days expiry time after the reconstitution.  

Conclusion 

I looked in this post at some essential information surrounding the use of amoxicillin in children. Patients/parents are advised to: 

• Follow the GP’s instructions on the dosage of liquid amoxicillin
• Cross-check the names of amoxicillin on the bottle with the name of product/amoxicillin dispensed. 
• Store liquid amoxicillin according to label instructions
• Familiarize themselves with the content of product information leaflet
• Store medicines away from children’s reach

References: 

NICE (2020). BNF: Amoxicillin. Available at: https://bnf.nice.org.uk/ Accessed on 17/06/2020