What is the appropriate dosage of Augmentin (amoxicillin-clavulanate) for a 13-year-old patient weighing 118 pounds with acute otitis media?

Augmentin Dosing for Acute Otitis Media in a 13-Year-Old Patient

For a 13-year-old patient weighing 118 pounds (53.5 kg) with acute otitis media, the appropriate dosage of Augmentin (amoxicillin-clavulanate) is 45 mg/kg/day of the amoxicillin component divided twice daily for 10 days. 1, 2

Dosage Calculation and Rationale

The recommended dosing for Augmentin in acute otitis media follows these guidelines:

• First-line therapy for acute otitis media is high-dose amoxicillin (80-90 mg/kg/day) 1
• For Augmentin specifically, the FDA-approved dosage for pediatric otitis media is 45 mg/kg/day of amoxicillin component divided every 12 hours for 10 days 2

For this 13-year-old patient weighing 53.5 kg:

• Total daily dose: 45 mg/kg/day × 53.5 kg = 2,407.5 mg/day of amoxicillin component
• Divided twice daily: approximately 1,200 mg per dose

Formulation Selection

• For a 13-year-old patient, the appropriate formulation would be Augmentin tablets
• The closest standard formulation would be Augmentin 875/125 mg tablets given twice daily
• This provides slightly less than the calculated dose but is within an acceptable range for a patient of this age and weight

Treatment Duration

• The recommended duration of treatment is 10 days 2
• Treatment should continue for at least 48-72 hours beyond symptom resolution 1

Clinical Evidence Supporting This Recommendation

Clinical trials have demonstrated that the twice-daily dosing regimen of Augmentin is as effective as three-times-daily dosing for otitis media, with significantly fewer gastrointestinal side effects:

• A clinical trial comparing 45 mg/kg/day divided every 12 hours versus 40 mg/kg/day divided every 8 hours showed comparable clinical efficacy rates (87% vs 82% at end of therapy) 2
• The twice-daily regimen had significantly lower rates of diarrhea (14% vs 34%) compared to the three-times-daily regimen 2

Important Considerations

• Pain management is essential and should be addressed immediately with acetaminophen or ibuprofen at age-appropriate doses 1
• Monitor for common adverse effects, primarily diarrhea and rash, which occur in up to 25% of patients 2
• Consider probiotic supplements to reduce gastrointestinal side effects 1

Common Pitfalls to Avoid

1. Underdosing the medication, which may lead to treatment failure, especially with resistant organisms
2. Focusing only on antibiotic therapy without adequate pain management
3. Not completing the full course of antibiotics even if symptoms improve quickly
4. Using decongestants or antihistamines, which are ineffective for otitis media 1

If the patient has penicillin allergy or fails to respond to initial therapy within 48-72 hours, alternative antibiotics should be considered according to clinical guidelines.