Augmentin ES-600 Dosing for 14 kg, 3-Year-Old Child
For a 14 kg, 3-year-old child, prescribe Augmentin ES-600 (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) at 6.0 mL twice daily for 10 days, providing the standard dose of 90 mg/kg/day of amoxicillin divided every 12 hours. 1
Dose Calculation
The FDA-approved dosing for Augmentin ES-600 is based on 90 mg/kg/day of the amoxicillin component, divided into two doses given every 12 hours 1:
- Weight: 14 kg
- Dose per day: 14 kg × 90 mg/kg = 1,260 mg amoxicillin daily
- Dose per administration: 1,260 mg ÷ 2 = 630 mg per dose
- Volume per dose: 630 mg ÷ 120 mg/mL = 5.25 mL, which rounds to 6.0 mL twice daily per FDA dosing table 1
According to the FDA label dosing table, a child weighing 12-16 kg receives 6.0 mL twice daily 1.
Total Quantity to Dispense
For a 10-day treatment course (the FDA-recommended duration) 1:
- Total doses: 2 doses/day × 10 days = 20 doses
- Total volume: 6.0 mL × 20 doses = 120 mL
- Dispense: One 125 mL bottle (reconstituted from powder with 110 mL water) 1
Key Administration Points
- Timing: Administer at the start of meals to minimize gastrointestinal intolerance and enhance clavulanate absorption 1
- Storage: Refrigerate after reconstitution; stable for 10 days 1
- Shake well before each use 1
Clinical Context
This high-dose formulation (90/6.4 mg/kg/day) is specifically designed for infections where resistant pathogens are suspected, particularly:
- Acute otitis media with recent antibiotic exposure (within 30 days) 2
- Recurrent or persistent infections 3, 2
- Children in daycare settings 3
- Children under 2 years of age 3
- Areas with high penicillin-resistant Streptococcus pneumoniae prevalence 3, 2
The ES-600 formulation provides 42.9 mg clavulanate per 5 mL (versus 28.5 mg or 57 mg in standard formulations), creating a 14:1 amoxicillin-to-clavulanate ratio that maintains adequate β-lactamase inhibition while delivering higher amoxicillin concentrations 1. This achieves middle ear fluid levels exceeding the MIC for penicillin-resistant S. pneumoniae (MIC ≤4 mcg/mL) 1, 4.
Safety Profile
In clinical trials, Augmentin ES-600 demonstrated:
- Diarrhea incidence: 11-13% (protocol-defined) 1
- Most common adverse events: Vomiting (6.5-6.9%), fever (5.5-6.1%), diaper rash (6.0-6.1%) 1
- No serious adverse events requiring discontinuation in pivotal trials 1
- Similar tolerability to standard-dose formulations 1
Critical Caveat
Augmentin ES-600 is NOT interchangeable with other Augmentin suspensions (200 mg/5 mL or 400 mg/5 mL) due to different clavulanate concentrations 1. Using standard formulations at equivalent amoxicillin doses would provide inadequate or excessive clavulanate exposure.