What is the dose of Augmentin (amoxicillin-clavulanate) for pneumonia in pediatric patients?

Dosing of Augmentin (Amoxicillin-Clavulanate) for Pediatric Pneumonia

For pediatric pneumonia, Augmentin (amoxicillin-clavulanate) should be dosed at 90 mg/kg/day of the amoxicillin component divided into 2 doses for outpatient treatment of presumed bacterial pneumonia. 1

Dosing Recommendations by Age Group

Outpatient Treatment

• Children <5 years old:

  • Amoxicillin-clavulanate: 90 mg/kg/day of amoxicillin component in 2 divided doses 1
  • Duration: 7-10 days 1

• Children ≥5 years old:

  • Amoxicillin-clavulanate: 90 mg/kg/day of amoxicillin component in 2 divided doses (maximum 4000 mg/day, e.g., one 2000-mg tablet twice daily) 1
  • Duration: 7-10 days 1

Inpatient Treatment

• Children 1 month to 12 years:

  • Intravenous amoxicillin-clavulanate: 30 mg/kg every 8 hours (based on amoxicillin component) 1
  • For severe infections, dosage frequency can be increased to 4 times daily 1
  • Duration: Based on clinical response and ability to tolerate oral treatment 1

• Children 12-18 years:

  • Intravenous amoxicillin-clavulanate: 1.2 g every 8 hours 1

Formulation Considerations

The British Thoracic Society guidelines note that Augmentin Duo is an alternative preparation that may be used 1. In the United States, high-dose amoxicillin-clavulanate formulations include:

• Augmentin ES-600: Contains 600 mg amoxicillin/42.9 mg clavulanate per 5 mL, providing a 14:1 ratio of amoxicillin to clavulanate 2
• This formulation was developed specifically for pediatric infections where drug-resistant pathogens are a concern 3

Special Considerations

Beta-lactamase Producing Organisms

For infections where beta-lactamase producing H. influenzae is suspected or confirmed:

• Oral: Amoxicillin-clavulanate with amoxicillin component at 45 mg/kg/day in 3 doses OR 90 mg/kg/day in 2 doses 1
• IV: 30 mg/kg every 8 hours 1

Penicillin-Resistant S. pneumoniae

For areas with high prevalence of penicillin-resistant S. pneumoniae:

• Consider high-dose amoxicillin-clavulanate formulations 3, 2
• The high-dose formulation provides adequate coverage against S. pneumoniae with reduced susceptibility to penicillin 3

Duration of Therapy

• Standard duration: 7-10 days 1
• May need up to 14 days depending on clinical response 1
• Recent evidence suggests that shorter courses (3 days) may be as effective as longer courses (7 days) for uncomplicated community-acquired pneumonia, with similar rates of antibiotic retreatment and adverse events 4

Common Pitfalls and Caveats

1. Dosing frequency: While traditional dosing was three times daily, twice-daily dosing with appropriate dose adjustments has been shown to maintain adequate plasma concentrations and may improve compliance 5

2. Formulation confusion: Be aware of the different formulations available with varying ratios of amoxicillin to clavulanate (4:1,7:1, and 14:1) 2

3. Monitoring: Children should demonstrate clinical improvement within 48-72 hours of starting therapy. If deterioration occurs or no improvement is seen within this timeframe, further investigation is warranted 1

4. Resistance concerns: In areas with high prevalence of drug-resistant S. pneumoniae, higher doses of the amoxicillin component are recommended 3, 2

5. Adverse effects: Monitor for common side effects including diarrhea, rash, and candidiasis 3

The evidence strongly supports using amoxicillin-clavulanate at appropriate doses based on age and severity of infection, with consideration for local resistance patterns to ensure optimal outcomes in terms of morbidity, mortality, and quality of life for children with pneumonia.