From the Guidelines
For a 7-year-old male weighing 20.4 kg with strep pharyngitis, I recommend Augmentin (amoxicillin-clavulanate) 250 mg/62.5 mg/5 mL suspension at a dose of 40-45 mg/kg/day of the amoxicillin component, divided into two doses, as the most recent and highest quality study 1 supports this dosing regimen. This translates to approximately 8-9 mL twice daily for 10 days. Each dose should be given approximately 12 hours apart, and the medication should be taken with food to minimize gastrointestinal side effects. The suspension should be refrigerated after reconstitution and shaken well before each use.
Key Considerations
- The dosing provides adequate coverage against Group A Streptococcus while the clavulanic acid component helps overcome potential beta-lactamase resistance.
- The 10-day duration is important to complete even if symptoms improve earlier, as this helps prevent complications like rheumatic fever.
- Common side effects may include diarrhea, nausea, and rash.
- If severe diarrhea or allergic reactions occur, medical attention should be sought immediately.
Evidence Support
- The Infectious Diseases Society of America guidelines 1 also support the use of amoxicillin-clavulanate for the treatment of streptococcal pharyngitis, but the most recent study 1 provides the most up-to-date dosing recommendations.
- The American Family Physician guidelines 1 recommend a dose of 40-45 mg/kg/day of the amoxicillin component, divided into two doses, which is consistent with the recommended dosing regimen.
From the Research
Amoxicillin-Clavulanate Dosing for Streptococcal Pharyngitis
- The appropriate dosing of Amoxicillin-Clavulanate (Augmentin) oral suspension for a 7-year-old male patient weighing 20.4 kilograms with streptococcal pharyngitis is not directly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that penicillin and amoxicillin are first-line antibiotics for streptococcal pharyngitis, with a recommended course of 10 days 5.
- The dosage of amoxicillin for children is typically based on their weight, but the exact dosage for a 20.4 kg child is not specified in the provided studies.
- A study on amoxicillin + clavulanic acid EXPRESS in the form of dispersible tablets for acute streptococcal tonsillopharyngitis in adults used a dosage of 875+125 mg 2 times a day at the beginning of meals 4, but this may not be applicable to children.
- Another study mentions that amoxicillin is the drug of choice for acute otitis media in children in Argentina, given the low penicillin resistance rates for S. pneumoniae, but does not provide a specific dosage for streptococcal pharyngitis 3.
Considerations for Antibiotic Therapy
- The choice of antibiotic therapy should be based on clinical decision rules, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 5.
- Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days; first-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 5.
- There is significant resistance to azithromycin and clarithromycin in some parts of the United States, and steroids are not recommended for symptomatic treatment 5.