Augmentin ES-600 Dosing for 28 kg Child with Otitis Media
For a 28 kg child with acute otitis media, the correct dose of Augmentin ES-600 (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) is 10.5 mL twice daily for 10 days. This provides the recommended 90 mg/kg/day of amoxicillin divided into two doses 1.
Dosing Calculation and Administration
The FDA-approved dosing table for Augmentin ES-600 specifically lists:
- 28 kg patient: 10.5 mL twice daily 1
- This delivers 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate
- Total daily dose: 2,520 mg amoxicillin / 180 mg clavulanate
- Duration: 10 days
Critical administration points:
- Give at the start of meals to minimize gastrointestinal side effects and enhance clavulanate absorption 1
- Shake suspension well before each use
- Store reconstituted suspension under refrigeration; stable for 10 days 1
When to Use High-Dose Amoxicillin-Clavulanate
The 2013 AAP guidelines specify that high-dose amoxicillin-clavulanate (rather than amoxicillin alone) should be first-line treatment when 2:
- Child has taken amoxicillin in the previous 30 days
- Concurrent purulent conjunctivitis is present
- Coverage for β-lactamase producing organisms (H. influenzae, M. catarrhalis) is desired
This formulation is specifically designed for resistant pathogens. Clinical trials demonstrated 98.4% bacteriologic eradication of S. pneumoniae (including 85.7% of strains with penicillin MIC = 4 mcg/mL) and 92.6% eradication of H. influenzae 1, 3.
Important Formulation Warning
Do NOT substitute other Augmentin suspensions for ES-600. The clavulanate concentrations differ significantly 1:
- ES-600: 42.9 mg clavulanate per 5 mL
- Standard 200 mg/5 mL: 28.5 mg clavulanate per 5 mL
- Standard 400 mg/5 mL: 57 mg clavulanate per 5 mL
These formulations are not interchangeable due to different amoxicillin-to-clavulanate ratios (14:1 for ES-600 vs. 7:1 for standard formulations).
Expected Side Effects
Protocol-defined diarrhea occurs in approximately 11-13% of children on this regimen 1. Diaper dermatitis affects 6-21% 1, 4. These rates are acceptable given the superior efficacy against resistant pathogens. Clinical success rates at 2-4 days post-therapy reach 89% for S. pneumoniae infections 1.
Clinical Efficacy
The ES-600 formulation achieves: