Is Augmentin (amoxicillin-clavulanate) given at 100 mg/kg/day for pediatric patients?

Amoxicillin-Clavulanate (Augmentin) Dosing in Pediatric Patients

No, Augmentin (amoxicillin-clavulanate) is not typically given at 100 mg/kg/day for pediatric patients. The standard dosing for amoxicillin-clavulanate varies by indication, but generally ranges from 25-45 mg/kg/day (of the amoxicillin component) divided into multiple doses.

Standard Pediatric Dosing Guidelines

The dosing of amoxicillin-clavulanate depends on several factors:

By Age and Weight

• Infants and children <40 kg:

  • For mild/moderate infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 1
  • For severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1

• Children <12 weeks (3 months):

  • Maximum recommended dose: 30 mg/kg/day divided every 12 hours 2
  • This lower dosing is due to incompletely developed renal function affecting drug elimination 2

By Indication

• Lower respiratory tract infections:

  • 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1

• Ear/nose/throat, skin/skin structure, genitourinary tract infections:

  • Mild/moderate: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 1
  • Severe: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1

Special Formulations and Situations

• High-dose formulation (Augmentin ES-600):

  • Used for resistant organisms: 90/6.4 mg/kg/day of amoxicillin/clavulanate in two divided doses 3
  • Specifically developed for penicillin-resistant strains of S. pneumoniae

• Twice-daily formulation (Augmentin-Duo):

  • 25/3.6 mg/kg/day divided into two doses 4
  • Designed to improve compliance compared to three-times-daily dosing

Clinical Considerations

• Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 2
• For Streptococcus pyogenes infections, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 2
• Dosage adjustment is required for patients with severe renal impairment (GFR <30 mL/min) 2

Common Dosing Errors to Avoid

1. Using 100 mg/kg/day as a standard dose (this is higher than recommended)
2. Not adjusting dosage for age, particularly in infants under 12 weeks
3. Not considering the severity of infection when selecting dosage
4. Failing to complete the full course of treatment

While one older study from 1986 mentioned using 100-200 mg/kg/day for intravenous Augmentin in hospitalized children 5, this is not the current standard recommendation for routine use, especially for oral formulations. Always refer to current guidelines and FDA-approved dosing recommendations when prescribing amoxicillin-clavulanate.