What dose of amoxicillin‑clavulanate suspension (457 mg per 5 mL) should be given to a 3‑year‑old child weighing 11 kg?

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Last updated: October 17, 2026 • View editorial policy

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Dosing Calculation for Amoxicillin-Clavulanate 457 mg/5 mL

For an 11 kg, 3-year-old child, give 5.5 mL of the 457 mg/5 mL suspension twice daily (every 12 hours).

Calculation Breakdown

The 457 mg/5 mL formulation contains:

  • 400 mg amoxicillin per 5 mL
  • 57 mg clavulanate per 5 mL

This is the high-dose formulation (also called ES-600 or 600 mg/42.9 mg per 5 mL in some markets).

Standard Dosing for Common Infections

For otitis media, sinusitis, lower respiratory tract infections, and more severe infections, the recommended dose is 45 mg/kg/day of amoxicillin component divided every 12 hours 1, 2, 3.

Calculation:

  • 45 mg/kg/day × 11 kg = 495 mg/day total
  • Divided into 2 doses = 247.5 mg per dose
  • The 457 mg/5 mL suspension provides 400 mg amoxicillin per 5 mL
  • Therefore: (247.5 mg ÷ 400 mg) × 5 mL = 3.1 mL per dose

However, the FDA-approved dosing table for this specific formulation (400 mg/57 mg per 5 mL) typically uses 90 mg/kg/day for more severe infections 3.

For high-dose therapy (90 mg/kg/day):

  • 90 mg/kg/day × 11 kg = 990 mg/day
  • Divided into 2 doses = 495 mg per dose
  • (495 mg ÷ 400 mg) × 5 mL = 6.2 mL per dose

Clinical Context Matters

For less severe infections: Use 25 mg/kg/day divided every 12 hours 1, 2, 3

  • This equals approximately 1.7 mL twice daily for this child

For moderate infections (standard dose): Use 45 mg/kg/day divided every 12 hours 1, 2

  • This equals approximately 3.1 mL twice daily for this child

For severe infections or resistant organisms: Use 80-90 mg/kg/day divided every 12 hours 1, 2, 4

  • This equals approximately 5.5-6.2 mL twice daily for this child

Practical Recommendation

The most commonly prescribed dose for this formulation is 5.5 mL twice daily, which provides approximately 88 mg/kg/day of amoxicillin—appropriate for:

  • Acute otitis media (especially recurrent or treatment failure)
  • Acute bacterial sinusitis
  • Community-acquired pneumonia
  • Any infection where β-lactamase-producing organisms or resistant Streptococcus pneumoniae are suspected 1, 2, 4

Important Caveats

  • This high-concentration formulation (457 mg/5 mL) is specifically designed to deliver high-dose amoxicillin with reduced clavulanate to minimize diarrhea while maintaining efficacy 5, 6
  • The clavulanate dose with this formulation is approximately 6.4 mg/kg/day, which is half the standard 12.8 mg/kg/day but remains sufficient to inhibit β-lactamase 5
  • Always administer at the start of meals to enhance clavulanate absorption and reduce gastrointestinal side effects 3
  • Round to the nearest 0.5 mL for practical measurement using oral syringes

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.