Dosage of Amoxicillin/Clavulanic Acid Syrup in Children
The recommended dose of amoxicillin/clavulanic acid (Augmentin) syrup for children is 45 mg/kg/day divided into 2 doses for mild to moderate infections, and 90 mg/kg/day divided into 2 doses for severe infections.
Standard Dosing Recommendations
By Severity of Infection:
Mild to Moderate Infections:
Severe Infections:
- 90 mg/kg/day divided into 2 doses (every 12 hours) 1
- This high-dose regimen is particularly important in communities with high prevalence of non-susceptible S. pneumoniae (>10%)
Age-Specific Considerations:
Children <3 months (12 weeks):
- Due to incompletely developed renal function, the recommended upper dose is 30 mg/kg/day divided every 12 hours 2
Children ≥3 months with weight <40 kg:
For ear/nose/throat, skin/skin structure, and genitourinary tract infections:
- Mild/Moderate: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours
- Severe: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
For lower respiratory tract infections:
- 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours regardless of severity 2
Special Populations and Considerations
Children with Risk Factors for Resistant Organisms:
Children with the following risk factors should receive high-dose amoxicillin/clavulanic acid (90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses):
- Age younger than 2 years
- Attendance at child care
- Recent antimicrobial treatment (within previous 30 days) 1
Renal Impairment:
- Children with impaired renal function generally don't require dose reduction unless impairment is severe
- For severe renal impairment (GFR <30 mL/min), dose adjustment is necessary 2
Administration Guidelines
- Administer at the start of a meal to minimize gastrointestinal intolerance 2
- Shake oral suspension well before using
- After reconstitution, any unused portion must be discarded after 14 days
- Refrigeration is preferable but not required 2
Treatment Duration
- Treatment should continue for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 2
- For infections caused by Streptococcus pyogenes, a minimum of 10 days' treatment is recommended to prevent acute rheumatic fever 2
- For most common infections, 7-10 days of treatment is typically recommended 1
Common Pitfalls to Avoid
- Underdosing: Using standard doses in areas with high prevalence of resistant organisms
- Improper dosing frequency: The twice-daily regimen has shown comparable efficacy to thrice-daily dosing with potentially better compliance 3
- Age-based rather than weight-based dosing: Always calculate dosage based on the child's weight rather than age for more accurate dosing 4
- Failure to adjust for severity: Not increasing the dose for severe infections or when resistant pathogens are suspected
- Inadequate duration: Stopping treatment too early before bacterial eradication is achieved
Formulation Considerations
The high-dose formulation of amoxicillin/clavulanic acid (90/6.4 mg/kg/day in two divided doses) is particularly valuable for treating infections caused by penicillin-intermediate and resistant S. pneumoniae 5. This formulation provides a 14:1 ratio of amoxicillin to clavulanate in an oral suspension, optimized for pediatric use 1.
When prescribing amoxicillin/clavulanic acid, always include on the prescription: the daily dose, number of divided doses, duration of therapy, indication, and the child's weight to ensure safe and effective treatment 4.