What is the appropriate dose of Augmentin (amoxicillin/clavulanate) for a child for dog bite prophylaxis?

Amoxicillin-Clavulanate (Augmentin) Dosing for Dog Bite Prophylaxis in Children

For dog bite prophylaxis in children, amoxicillin-clavulanate should be dosed at 45 mg/kg/day of the amoxicillin component divided in two doses for mild to moderate cases, or 90 mg/kg/day in two divided doses for more severe cases or in areas with high antimicrobial resistance.

Dosing Recommendations

Standard Dosing

• Mild to moderate infections: 45 mg/kg/day of amoxicillin component in 2 divided doses
• Severe infections or high resistance areas: 90 mg/kg/day of amoxicillin component in 2 divided doses
• Maximum daily dose: 4000 mg/day of amoxicillin component (typically one 2000 mg tablet twice daily for older children/adolescents)

Age-Specific Considerations

• Children <40 kg: Use weight-based dosing as above
• Children ≥40 kg: Use adult dosing (875/125 mg twice daily for standard dose or 2000/125 mg twice daily for high dose)

Treatment Duration

• Standard duration: 5-7 days
• Treatment should continue for at least 48-72 hours after clinical improvement
• Consider extending treatment if inadequate response is observed within 48-72 hours

Rationale for Amoxicillin-Clavulanate

Amoxicillin-clavulanate is the preferred antibiotic for dog bite prophylaxis because:

1. It provides coverage against common pathogens in dog bites:

   • Streptococcus species
   • Staphylococcus species (including β-lactamase producers)
   • Pasteurella multocida
   • Capnocytophaga canimorsus
   • Anaerobes

2. The clavulanate component inhibits β-lactamase enzymes, protecting amoxicillin from degradation by β-lactamase-producing bacteria commonly found in dog bite wounds 1.

Clinical Considerations

Risk Factors for Severe Infection

• Deep puncture wounds
• Crush injuries
• Hand or face bites
• Immunocompromised patients
• Delayed presentation (>8 hours)

Administration Tips

• Administer with food to minimize gastrointestinal side effects 2
• Shake oral suspension well before using
• Any unused portion of reconstituted suspension must be discarded after 14 days

Common Pitfalls to Avoid

1. Inadequate dosing: Underdosing may lead to treatment failure, especially with potentially resistant organisms
2. Delayed treatment: Prophylaxis should be started as soon as possible after the bite
3. Insufficient duration: Premature discontinuation before clinical improvement may lead to treatment failure
4. Failure to consider local resistance patterns: In areas with high resistance, higher dosing may be necessary

Special Situations

Penicillin Allergy

For patients with non-severe penicillin allergy:

• Clindamycin (30-40 mg/kg/day in 3-4 divided doses) plus either TMP-SMX or a fluoroquinolone (in adolescents) 1, 3

Renal Impairment

For children with severe renal impairment (GFR <30 mL/min):

• Dose reduction required
• Avoid 875 mg dose formulations 2

Remember that early treatment with appropriate antibiotics is crucial for preventing infection after dog bites, and amoxicillin-clavulanate remains the first-line therapy due to its excellent coverage of the polymicrobial organisms typically involved in these injuries.