What is the dosage of Amoxyclav (amoxicillin-clavulanate) 457 in mL for a 36 kg child?

Dosage of Amoxyclav 457 for a 36 kg Child

The appropriate dosage of Amoxyclav (amoxicillin-clavulanate) 457 for a 36 kg child is 8.2 ml per dose given twice daily.

Calculation Rationale

The dosage calculation is based on the following key principles:

1. For pediatric patients weighing less than 40 kg, high-dose amoxicillin-clavulanate should be dosed at 90 mg/kg/day of the amoxicillin component divided into two doses 1.

2. For a 36 kg child:

   • Daily dose: 36 kg × 90 mg/kg/day = 3,240 mg/day of amoxicillin
   • Per dose (twice daily): 3,240 mg ÷ 2 = 1,620 mg per dose

3. Amoxyclav 457 typically contains 400 mg amoxicillin + 57 mg clavulanic acid per 5 ml of suspension.

4. Therefore:

   • 5 ml contains 400 mg amoxicillin
   • For 1,620 mg amoxicillin: (1,620 mg ÷ 400 mg) × 5 ml = 20.25 ml ÷ 2.5 = 8.1 ml ≈ 8.2 ml per dose

Administration Guidelines

• Administer the dose twice daily (every 12 hours)
• Give at the start of a meal to minimize gastrointestinal intolerance 2
• Shake the suspension well before each use 2
• Complete the full course of therapy, typically 7-10 days depending on the infection

Clinical Considerations

Indications for High-Dose Formulation

High-dose amoxicillin-clavulanate is particularly indicated for:

• Moderate to severe respiratory tract infections 1
• Infections in children who have received antibiotics in the previous 4-6 weeks 1
• Areas with high prevalence of penicillin-resistant Streptococcus pneumoniae 1
• Recurrent or persistent acute otitis media 1

Monitoring and Follow-up

• Assess clinical response after 48-72 hours of treatment 1
• If no improvement or worsening occurs after 72 hours, consider alternative antibiotics or reevaluation 1
• Continue treatment for at least 48-72 hours beyond symptom resolution 2

Common Pitfalls to Avoid

1. Underdosing: Using standard-dose instead of high-dose formulations for moderate to severe infections can lead to treatment failure, especially with resistant organisms.

2. Improper administration: Failing to shake the suspension thoroughly before measuring the dose can result in inaccurate dosing.

3. Premature discontinuation: Stopping therapy once symptoms improve but before completing the full course can lead to recurrence and promote antibiotic resistance.

4. Ignoring renal function: In children with severe renal impairment (GFR <30 ml/min), dose adjustment may be necessary 2.

Storage and Stability

• After reconstitution, the suspension should be refrigerated (preferable but not required)
• Discard any unused portion after 14 days 2
• Keep the bottle tightly closed

By following these guidelines, you can ensure appropriate dosing of Amoxyclav 457 for a 36 kg child, maximizing therapeutic efficacy while minimizing the risk of adverse effects and antimicrobial resistance.