Maximum Dose of Amoxicillin-Clavulanate for Pediatric IV Administration
For pediatric patients, the maximum recommended intravenous (IV) dose of amoxicillin-clavulanate is 200 mg/kg/day of the ampicillin component divided every 6 hours, with a maximum of 2 g per dose. 1
Dosing Guidelines by Age Group
Neonates and Young Infants
- Neonates: Limited specific IV amoxicillin-clavulanate dosing data available for this age group
- Infants: 100-150 mg ampicillin/kg/day divided every 6 hours 1
Children
- Children: 100-200 mg ampicillin/kg/day divided every 6 hours 1
- Standard ratio of amoxicillin to clavulanic acid for IV formulation is typically 5:1 2
Dosing Considerations for Specific Clinical Scenarios
Respiratory Infections
- For respiratory infections where penicillin-resistant S. pneumoniae is a concern, higher dosing may be required 3
- For oral formulations, high-dose amoxicillin-clavulanate (90 mg/6.4 mg per kg per day) has been recommended 1, but IV dosing should not exceed 200 mg/kg/day
Critically Ill Children
- Children after cardiac surgery may exhibit augmented clearance requiring more frequent dosing (every 4 hours instead of every 6 hours) to maintain adequate drug levels 4
- Patients receiving vasopressors may have decreased clearance (by approximately 1/3) and may maintain adequate levels with standard 6-hourly dosing 4
Important Clinical Considerations
Safety and Monitoring
- Monitor for adverse effects, particularly gastrointestinal disturbances
- Adjust dosing in patients with renal impairment
- Maximum single dose should not exceed 2 g of the ampicillin component 1
Pharmacokinetic Considerations
- Terminal phase plasma half-lives are approximately 1.2 hours for amoxicillin and 0.8 hours for clavulanic acid in pediatric patients 2
- Therapeutic drug monitoring may be beneficial in critically ill patients to ensure adequate drug exposure
Common Pitfalls to Avoid
- Underdosing in severe infections: Inadequate dosing may lead to treatment failure, particularly with resistant organisms
- Failure to adjust for renal function: Amoxicillin-clavulanate is primarily eliminated by the kidneys
- Overlooking the need for more frequent dosing in patients with augmented clearance: Some critically ill children may require more frequent administration 4
- Not considering local resistance patterns: Dosing may need to be adjusted based on local antimicrobial resistance data
Practical Administration Tips
- IV amoxicillin-clavulanate should be administered as an infusion over 30 minutes to minimize vein irritation
- Transition to oral therapy when clinically appropriate to reduce risks associated with IV access
Remember that while the maximum recommended dose is 200 mg/kg/day of the ampicillin component, the actual dose should be determined based on the severity of infection, suspected pathogens, and the patient's clinical condition.