Amoxicillin in the treatment of acute respiratory infections in children: a dialogue between a microbiologist and a clinical pharmacologist

The article presents a modern view of amoxicillin in the treatment of acute respiratory infections in children from point of view of a microbiologist and clinical pharmacologist. Modern microbiological methods have changed the idea of the microbiota of the respiratory tract, however, the etiology of acute bacterial infections of the respiratory tract has not undergone significant changes – Streptococcus pneumoniae and Haemophilus influenzae are still the most common pathogens. Amoxicillin remains the drug of choice for most respiratory infections of bacterial etiology. Inhibitor-protected aminopenicillins (amoxicillin/clavulanate etc.) do not have advantages over amoxicillin in most cases of acute respiratory tract infections, but increase the risk of adverse events. Current data on macrolides, which are widely used in clinical practice, indicate the need to limit their use in acute infections of the respiratory tract due to the increase in resistance of S. pneumoniae and the absence of clinically significant activity against H. influenza. Current information on the resistance of S. pneumoniae and H. influenzae, as well as available data on the pharmacokinetics of amoxicillin, require a review of dosing approaches. The daily dose of amoxicillin in children with acute respiratory infections should not be less than 45–60 mg/kg, and in many cases (acute otitis media, infections caused by H. influenzae or penicillin-resistant S. pneumoniae strains), more than 90 mg/kg/day is required. Amoxicillin has a wide therapeutic range, and therefore the use of high doses of the drug is not associated with a decrease in the safety of therapy.