Co-Amoxiclav Dosage for Pneumonia in Syrup
For pediatric community-acquired pneumonia, co-amoxiclav oral suspension should be dosed at 90 mg/kg/day (based on the amoxicillin component) divided into 2 doses every 12 hours for children 3 months and older, using either the 200 mg/28.5 mg per 5 mL or 400 mg/57 mg per 5 mL formulations. 1
Age-Specific Dosing
Neonates and Infants < 3 Months
- 30 mg/kg/day divided every 12 hours (based on amoxicillin component)
- Use the 125 mg/31.25 mg per 5 mL suspension (the 200 mg formulation has limited experience in this age group) 2
Children ≥ 3 Months
The dosing depends on infection severity:
For Lower Respiratory Tract Infections and More Severe Pneumonia:
- 45 mg/kg/day every 12 hours using 200 mg/28.5 mg or 400 mg/57 mg per 5 mL suspension 2
- Alternative: 40 mg/kg/day every 8 hours using 125 mg/31.25 mg or 250 mg/62.5 mg per 5 mL suspension 2
Important Note: The every 12-hour regimen is preferred as it causes significantly less diarrhea 2. However, the 200 mg and 400 mg formulations contain aspartame and should not be used in phenylketonuric patients 2.
Children ≥ 40 kg
Dose according to adult recommendations:
- 875 mg/125 mg tablet every 12 hours for respiratory tract infections 2
- Alternative: 500 mg/125 mg tablet every 8 hours 2
Clinical Context from Guidelines
The PIDS/IDSA guidelines position co-amoxiclav as an alternative to first-line amoxicillin for outpatient bacterial pneumonia 1. The primary indication for co-amoxiclav over plain amoxicillin is when β-lactamase-producing organisms (particularly Haemophilus influenzae) are suspected 1.
For empiric therapy:
- Children < 5 years: Plain amoxicillin (90 mg/kg/day) is preferred; co-amoxiclav is listed as an alternative 1
- Children ≥ 5 years: Plain amoxicillin remains preferred unless β-lactamase production is suspected 1
Critical Pitfalls to Avoid
Do not substitute formulations interchangeably: The 250 mg/125 mg tablet contains 125 mg clavulanate, while the 250 mg/62.5 mg chewable contains only 62.5 mg clavulanate. These are NOT equivalent 2
Different ratios for different indications: The higher dose formulations (90 mg/kg/day) are specifically designed for pneumonia and more severe infections, not just any respiratory infection 2
Phenylketonuria screening: Always check before prescribing the 200 mg or 400 mg suspensions 2
Duration matters: For pneumonia, typical treatment courses are 7-10 days, though the evidence supports 5-day courses in some cases 3, 4
Second-Line Considerations
If treatment failure occurs after 48-72 hours with first-line amoxicillin, co-amoxiclav at 80-90 mg/kg/day can serve as second-line therapy 5. This higher dose provides enhanced coverage against resistant organisms while maintaining β-lactamase coverage.
Adult Dosing (for completeness)
For adults with pneumonia, the pharmacokinetically enhanced formulation 2000 mg/125 mg twice daily has demonstrated superior efficacy against resistant Streptococcus pneumoniae strains 4, 6, 7. Standard adult dosing of 875 mg/125 mg twice daily remains appropriate for most community-acquired pneumonia cases 2.