Pediatric Augmentin (Amoxicillin-Clavulanate) Dosing Guidelines
The recommended dosage of Augmentin (amoxicillin-clavulanate) for pediatric patients is 90 mg/kg/day of the amoxicillin component divided into two doses (45 mg/kg twice daily) for most infections, with a maximum of 4g/day. This dosing regimen provides optimal therapeutic coverage while minimizing adverse effects.
Dosing by Age and Weight
Children ≥3 months and <40 kg:
- Standard dose: 45 mg/kg/dose twice daily (90 mg/kg/day)
- Alternative: 20-40 mg/kg/day divided every 8 hours for mild-moderate infections 1
Children ≥3 months and ≥40 kg:
- 500 mg every 12 hours or 250 mg every 8 hours 1
Neonates and infants <3 months:
- Dosing should be adjusted based on renal function and severity of infection
- Consult with pediatric infectious disease specialist
Dosing by Indication
Respiratory Tract Infections
- Community-acquired pneumonia: 90 mg/kg/day divided into 2 doses 2
- Otitis media: 90 mg/kg/day divided into 2 doses 3
Intra-abdominal Infections
- Complicated intra-abdominal infections: 200 mg/kg/day of ampicillin component divided every 6 hours 1
Skin and Soft Tissue Infections
- Mild to moderate: 25 mg/kg/day divided every 12 hours 1
- Severe: 200-300 mg/kg/day of ampicillin component divided every 6 hours 1
Formulations and Administration
- Oral suspension: Available in multiple concentrations (125 mg/5mL, 200 mg/5mL, 250 mg/5mL, 400 mg/5mL, 600 mg/5mL)
- Tablets: Available in multiple strengths (250 mg, 500 mg, 875 mg)
- Administration: Should be given with food to improve gastrointestinal tolerance and absorption 4
Duration of Therapy
- Standard course: 7-10 days for most infections
- Complicated infections: May require longer treatment (10-14 days)
- Otitis media: 7-10 days, with evidence supporting shorter 5-day courses for uncomplicated cases in children >2 years 3
Monitoring and Adverse Effects
Common Adverse Effects
- Diarrhea (7-11% of patients)
- Nausea/vomiting
- Skin rash
Serious Adverse Effects (Rare)
- Hypersensitivity reactions
- Stevens-Johnson syndrome
- Clostridium difficile-associated diarrhea
- Hepatic dysfunction
Monitoring
- Clinical response within 48-72 hours
- Assess for adverse effects, particularly diarrhea
- Consider liver function tests for prolonged therapy
Special Considerations
- Renal impairment: Dose adjustment required
- Penicillin allergy: Contraindicated in patients with history of serious hypersensitivity reactions to penicillins 1
- Twice-daily dosing: Improves compliance compared to three-times-daily regimens (82.8% vs 73.3%) 3
Clinical Pearls
- The twice-daily formulation has equivalent efficacy to three-times-daily dosing with better compliance 3
- Higher doses may be needed for suspected resistant organisms
- Augmentin should be used with caution in patients with hepatic impairment
- For intravenous therapy in hospitalized children, dosages of 100-200 mg/kg/day divided into 3-4 doses are recommended 5
By following these dosing guidelines, clinicians can optimize therapeutic outcomes while minimizing adverse effects in pediatric patients requiring treatment with amoxicillin-clavulanate.