Dosage Recommendation for Augmentin 200-28.5 mg/5ml Suspension
For a child weighing 16.33 kg, administer 6 ml of Augmentin 200-28.5 mg/5ml suspension twice daily (every 12 hours).
Calculation Rationale
The standard dosing for Augmentin suspension (200 mg amoxicillin/28.5 mg clavulanate per 5 ml) depends on the indication and severity:
Standard Dosing (45 mg/kg/day of amoxicillin component):
- 16.33 kg × 45 mg/kg/day = 735 mg/day
- Divided into 2 doses = 367.5 mg per dose
- Volume needed: (367.5 mg ÷ 200 mg) × 5 ml = 9.2 ml twice daily
However, this formulation is typically dosed at 25 mg/kg/dose twice daily for most common pediatric infections 1:
- 16.33 kg × 25 mg/kg = 408 mg per dose
- Volume needed: (408 mg ÷ 200 mg) × 5 ml = 10.2 ml twice daily
High-Dose Regimen (90 mg/kg/day of amoxicillin component):
For recurrent infections, treatment failures, or suspected resistant organisms 2, 3, 1:
- 16.33 kg × 90 mg/kg/day = 1470 mg/day
- Divided into 2 doses = 735 mg per dose
- Volume needed: (735 mg ÷ 200 mg) × 5 ml = 18.4 ml twice daily
Clinical Context Matters
The specific dose depends on the infection being treated:
Mild-to-moderate infections (uncomplicated otitis media, sinusitis, pharyngitis in low-risk patients): Standard dose of 45 mg/kg/day 2, 3
Recurrent/persistent infections or high-risk scenarios (recent antibiotic use within 30 days, daycare attendance, age <2 years, treatment failure, suspected resistant organisms): High-dose 90 mg/kg/day 2, 3, 1
Beta-lactamase producing organisms (H. influenzae, M. catarrhalis): The clavulanate component at 6.4 mg/kg/day is adequate 4, 2
Important Caveats
Critical limitation: The 200-28.5 mg/5ml formulation provides only 28.5 mg clavulanate per 5 ml, which may be insufficient for high-dose amoxicillin regimens. The FDA-approved high-dose formulation (Augmentin ES-600) contains 600 mg amoxicillin/42.9 mg clavulanate per 5 ml specifically to maintain appropriate clavulanate levels when using 90 mg/kg/day amoxicillin 1.
If high-dose therapy is indicated (90 mg/kg/day), the 200-28.5 mg/5ml suspension is not the optimal formulation. Consider:
- Switching to Augmentin ES-600 (600-42.9 mg/5ml): 6 ml twice daily for this 16.33 kg child 1
- Alternative: Use separate amoxicillin suspension at high dose
Administration: Give at the start of meals to minimize gastrointestinal side effects and enhance clavulanate absorption 1. Shake suspension well before each dose. Refrigerate after reconstitution and discard after 10 days 1.
Compliance consideration: Twice-daily dosing shows equivalent efficacy to three-times-daily regimens with trends toward better compliance and fewer adverse events 5, 6.