What is the recommended dosage of Amoclavin (amoxicillin/clavulanic acid) for a 36 kg child?

Amoxicillin/Clavulanic Acid Dosage for a 36 kg Child

For a 36 kg child, the recommended dosage of Amoxicillin/Clavulanic acid (Amoclavin) is 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses, which equals approximately 1620 mg amoxicillin with 115 mg clavulanate per day (810 mg amoxicillin with 57.5 mg clavulanate twice daily).

Dosage Calculation and Rationale

The dosage recommendation is based on the following considerations:

• For a 36 kg child, the high-dose amoxicillin-clavulanate regimen is most appropriate, especially when treating respiratory infections where resistant organisms may be a concern 1.
• The calculation: 90 mg/kg/day × 36 kg = 3240 mg/day of amoxicillin component
• Since the child weighs less than 40 kg, the pediatric dosing guidelines apply 2.
• The maximum dose should not exceed 2000 mg per dose 2.

Indications for High-Dose Formulation

High-dose amoxicillin-clavulanate is particularly indicated for:

• Children with moderate to severe infections 1
• Children under age 2 years (though this doesn't apply to a 36 kg child, who would typically be older)
• Recent antimicrobial exposure within the past 30 days
• Attendance at childcare facilities
• Areas with high prevalence of resistant S. pneumoniae (>10%) 1

Administration Guidelines

• The medication should be administered at the start of a meal to minimize gastrointestinal intolerance 2.
• Treatment should be continued for a minimum of 48-72 hours beyond the time that the patient becomes asymptomatic 2.
• For respiratory infections, a full course of therapy (typically 5-10 days) is recommended 1.
• The suspension should be shaken well before using 2.

Common Pitfalls to Avoid

1. Underdosing: Using standard-dose amoxicillin-clavulanate (45 mg/kg/day) may be inadequate for areas with high prevalence of resistant S. pneumoniae 1.

2. Inappropriate formulation selection: Ensure you're using the pediatric formulation with the 14:1 ratio of amoxicillin to clavulanate, which is less likely to cause diarrhea than other preparations 1.

3. Inadequate duration: Treatment should continue for at least 48-72 hours after symptoms resolve 2.

4. Poor timing with meals: Administration without food increases the risk of gastrointestinal side effects 2.

5. Failure to reassess: If no clinical improvement is observed within 48-72 hours, the patient should be reassessed and therapy potentially modified 1.

Alternative Options

If the patient has a non-type I hypersensitivity reaction to penicillins, alternative options include:

• Cefdinir
• Cefpodoxime
• Cefuroxime 1

For type I hypersensitivity reactions, macrolides may be considered, though they have lower efficacy against common respiratory pathogens 1.