Injectable Amoxicillin-Clavulanic Acid Dosage
The recommended dose of injectable amoxicillin-clavulanic acid for children is 40 mg/kg/day of the amoxicillin component divided into three doses, with a maximum of 2,000 mg amoxicillin per day. 1
Dosing Guidelines by Age Group
Pediatric Dosing
- Standard dose: 40 mg/kg/day of amoxicillin component divided into three doses 1
- For severe infections: Can be increased to 90 mg/kg/day of amoxicillin component divided into two doses 2
- Maximum daily dose: 2,000 mg of amoxicillin component 1
Adult Dosing
- Standard dose: 1.2 g (1000 mg amoxicillin/200 mg clavulanic acid) IV every 8 hours 3
- For severe infections: May require increased frequency to 6 times daily to achieve optimal pharmacodynamic targets 3
Clinical Considerations for Dosing
Infection Severity
- For mild to moderate infections: Standard dosing is typically sufficient
- For severe infections or suspected resistant organisms: Higher dosing may be necessary
- For chronic carriers of Group A Streptococcus: 40 mg amoxicillin per kg per day in three doses for 10 days 1
Special Populations
- Renal impairment: Dose adjustment required based on creatinine clearance
- Hepatic impairment: Monitor liver function; dose adjustment may be necessary
- Endocarditis prophylaxis: For high-risk patients, ampicillin 50 mg per kg IV within 30 minutes of procedure 1
Pharmacokinetic Considerations
Injectable amoxicillin-clavulanic acid has better bioavailability compared to oral formulations, with higher peak serum concentrations. The pharmacodynamic efficacy target of amoxicillin is 40% time above the minimal inhibition concentration (40%T > MIC) 3.
Studies have shown that standard dosing may not achieve optimal pharmacodynamic targets in all patients, particularly for organisms with higher MICs (≥8 mg/L) 3. In such cases, increased dosing frequency rather than increased individual doses may be more effective.
Common Pitfalls and Caveats
- Underdosing: Using standard doses for severe infections may lead to treatment failure, particularly with resistant organisms 3
- Duration: Continuing antibiotics beyond 7-10 days for uncomplicated infections contributes to antibiotic resistance without additional benefit
- Adjunctive therapy: Antibiotics alone may be insufficient if drainage is needed for abscesses
- Resistance patterns: In areas with high resistance, higher doses may be required
- Allergic reactions: Monitor for hypersensitivity reactions, particularly in patients with penicillin allergy history
- Cephalosporins: Should not be used in individuals with immediate-type hypersensitivity reaction to penicillins 1
For optimal outcomes in terms of morbidity and mortality, ensure appropriate dosing based on the severity of infection, local resistance patterns, and patient-specific factors.