Is 7.4 mL of Augmentin (amoxicillin-clavulanate) 200/28.5 for 10 days an appropriate treatment for periorbital cellulitis in a 3-year-old child weighing 52 pounds?

From the Guidelines

I strongly advise against using 7.4 mL of Augmentin 200/28.5 for 10 days in a 3-year-old with periorbital cellulitis weighing 52 pounds, as it is likely underdosed based on current guidelines. For periorbital cellulitis, the typical dosing of amoxicillin-clavulanate is 45 mg/kg/day divided twice daily based on the amoxicillin component, as recommended by the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1. For a child weighing 52 pounds (approximately 23.6 kg), this would equate to about 1,062 mg daily or 531 mg per dose twice daily. The Augmentin 200/28.5 suspension contains 200 mg amoxicillin per 5 mL, so 7.4 mL would deliver approximately 296 mg per dose, which appears insufficient for this child's weight.

Some key considerations for treating periorbital cellulitis include:

• The potential for rapid progression and serious complications, such as vision loss or intracranial spread
• The need for prompt evaluation by a healthcare provider to determine appropriate treatment
• The possibility of requiring hospitalization for more severe cases
• The importance of considering the child's weight and medical history when determining the appropriate antibiotic dose

Given the potential severity of periorbital cellulitis, it is crucial to prioritize the child's safety and ensure they receive adequate treatment. The recommended dose of amoxicillin-clavulanate for this child should be based on their weight, with a standard dose of 45 mg/kg per day in 2 divided doses, as suggested by the guideline 1. This would help ensure the child receives an effective dose of the antibiotic, reducing the risk of treatment failure and potential complications.

From the FDA Drug Label

For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours Patients Weighing 40 kg or More: Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations

The dose of 7.4 mL of Augmentin (amoxicillin-clavulanate) 200/28.5 for a 3-year-old child weighing 52 pounds is not explicitly stated in the provided drug label. To determine the appropriate dose, we need to calculate the dose based on the child's weight.

• The recommended dose for more severe infections is 45 mg/kg/day every 12 hours for patients aged 12 weeks and older.
• For a child weighing 52 pounds (approximately 23.6 kg), the dose would be:
  • 45 mg/kg/day * 23.6 kg = 1062 mg/day
  • Divided every 12 hours: 1062 mg / 2 = 531 mg per dose Since the provided dose of 7.4 mL of Augmentin 200/28.5 is not directly calculable from the label, and the calculated dose is not explicitly matched with the provided dose, no conclusion can be drawn. 2

From the Research

Treatment of Periorbital Cellulitis

• The treatment of periorbital cellulitis typically involves the use of antibiotics, with the goal of preventing serious complications and promoting recovery 3, 4, 5.
• The choice of antibiotic may depend on the suspected causative organism, with common pathogens including Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis 3, 5.
• In the case of a 3-year-old child weighing 52 pounds with periorbital cellulitis, the use of amoxicillin-clavulanic acid (Augmentin) may be appropriate, as it is a commonly used antibiotic for this condition 6.
• The dosage of 7.4 mL of Augmentin 200/28.5 for 10 days may be considered adequate, although the optimal dosage and duration of treatment may vary depending on the specific circumstances of the case.

Considerations for Treatment

• It is essential to recognize periorbital cellulitis promptly and treat it carefully to prevent vision and life-threatening complications 7.
• Hospitalization, prompt systemic antibiotic therapy, and careful monitoring for signs of sepsis and local invasion are critical in the management of periorbital cellulitis 7, 6.
• In some cases, surgical intervention may be necessary, particularly if there is evidence of an orbital abscess or other complications 3, 4, 5, 6.
• The use of steroid treatment may also be considered in some cases, although its role in the management of periorbital cellulitis is not well established 6.

Outcome of Treatment

• With prompt and appropriate treatment, most children with periorbital cellulitis can expect a good outcome, with minimal risk of long-term complications 4, 5, 6.
• The outcome of treatment may depend on various factors, including the severity of the infection, the promptness and adequacy of treatment, and the presence of any underlying medical conditions 3, 4, 5, 6.