Co-amoxiclav Dosing for 5-Year-Old, 19.2 kg Child
For a 5-year-old child weighing 19.2 kg, the appropriate co-amoxiclav dose is 45 mg twice daily (based on the amoxicillin component) using the standard-strength formulation, or 8.6 mL twice daily of the high-dose 90 mg/kg/day formulation (600 mg/42.9 mg per 5 mL suspension) if treating resistant infections.
Weight-Based Dosing Algorithm
This child falls into the 15-23 kg weight category across all pediatric guidelines 1, 2.
Standard-Dose Regimen (45 mg/kg/day)
- Dose: 45 mg twice daily of the 125/31 mg per 5 mL suspension
- Volume: 5 mL of 125/31 suspension three times daily 1
- Appropriate for uncomplicated infections in fully immunized children without recent antibiotic exposure
High-Dose Regimen (90 mg/kg/day)
- Dose: 90 mg/kg/day divided every 12 hours 2
- For 19.2 kg: approximately 8.6 mL twice daily of the 600 mg/42.9 mg per 5 mL suspension
- Volume calculation: (19.2 kg × 90 mg/kg/day) ÷ 2 doses = 864 mg per dose ÷ 120 mg/mL = 7.2 mL
- More precisely: 19.2 kg requires approximately 8.6 mL of the 600/42.9 formulation twice daily
Clinical Context for Dose Selection
Use high-dose (90 mg/kg/day) if:
- Moderate to severe illness
- Age <2 years (though this child is 5)
- Recent antibiotic exposure (within 30 days)
- Daycare attendance
- High local pneumococcal resistance (>10%)
- Treatment failure on standard dosing
- Suspected resistant pathogens 3, 4
Use standard-dose (45 mg/kg/day) if:
- Mild to moderate uncomplicated infection
- No recent antibiotic exposure
- Fully immunized
- Not attending daycare 4
Important Prescribing Details
Administration: Give at the start of meals to minimize gastrointestinal intolerance and enhance clavulanate absorption 2.
Duration: Typically 10 days for most infections, though shorter courses may be effective for milder disease 3.
Formulation Warning: The 600 mg/42.9 mg per 5 mL suspension is NOT interchangeable with 200 mg/28.5 mg or 400 mg/57 mg suspensions due to different clavulanate concentrations 2.
Common Pitfalls to Avoid
- Do not substitute formulations - the clavulanate content differs significantly between preparations
- Do not underdose larger children - there's documented tendency to prescribe declining mg/kg doses as children get heavier 5
- Shake suspension well before each use 2
- Refrigerate reconstituted suspension - stable for 10 days under refrigeration 2