Amoxicillin-Clavulanate Dosing for Pediatric UTI in a 124 lb Child
For a pediatric patient weighing 124 pounds (56 kg) with a urinary tract infection, the recommended dose of amoxicillin-clavulanate is 45 mg/kg/day divided every 12 hours, which equals approximately 2.5 grams per day in two divided doses. 1
Dosing Calculation
- Weight conversion: 124 pounds = 56 kg
- Based on FDA labeling for pediatric patients:
- Since this patient weighs more than 40 kg, adult dosing recommendations apply 1
- For UTIs, which are considered moderate infections, the appropriate dose is:
- 875 mg amoxicillin/125 mg clavulanate every 12 hours
- OR 500 mg amoxicillin/125 mg clavulanate every 8 hours
Treatment Duration
- The recommended duration of antimicrobial therapy for UTI is 7 to 14 days 2
- This duration has been shown to be effective in preventing complications and reducing the likelihood of renal damage
Administration Guidelines
- Administer at the start of a meal to minimize gastrointestinal intolerance 1
- Absorption of clavulanate potassium is enhanced when taken with food
Special Considerations
- For patients with suspected antimicrobial resistance or those who have recently been treated with antibiotics, high-dose amoxicillin-clavulanate (80-90 mg/kg/day of the amoxicillin component) may be more appropriate 2
- Local patterns of susceptibility should be considered when selecting antimicrobial therapy for UTIs 2
Monitoring and Follow-up
- Clinical improvement should be assessed within 48-72 hours of initiating treatment
- Signs of improvement include:
- Decreased fever
- Reduced urinary symptoms
- Improved overall condition
Cautions
- Avoid nitrofurantoin for febrile UTIs as it does not achieve therapeutic concentrations in the bloodstream and may be insufficient to treat pyelonephritis 2
- For patients with renal impairment (GFR <30 mL/min), the 875 mg/125 mg dose should not be used 1
- If the patient has a history of penicillin allergy, alternative agents should be considered
Alternative Regimens
If amoxicillin-clavulanate is not appropriate due to allergies or other contraindications, the following alternatives can be considered:
- Cephalosporins (if no history of anaphylaxis to penicillins)
- Trimethoprim-sulfamethoxazole (depending on local resistance patterns) 2
By following these dosing recommendations, you can effectively treat a pediatric UTI while minimizing the risk of antimicrobial resistance and optimizing clinical outcomes.