What is the dose of Augmentin (amoxicillin/clavulanic acid) tablets for a pediatric patient with a urinary tract infection (UTI) who cannot take the liquid form?

Pediatric Augmentin Tablet Dosing for UTI

For pediatric patients with UTI who cannot take liquid Augmentin (amoxicillin/clavulanic acid), the recommended tablet dosage is 20-40 mg/kg/day of amoxicillin component divided every 12 hours for children weighing 40 kg or more.

Dosing Guidelines

Weight-Based Dosing (Preferred Method)

• Children ≥40 kg: Use adult dosing of one 500/125 mg tablet every 12 hours
• For more severe UTIs: One 875/125 mg tablet every 12 hours

Important Considerations

• Tablets should not be used in children weighing less than 40 kg due to the different amoxicillin/clavulanic acid ratio compared to pediatric formulations 1
• Tablets should be taken at the start of a meal to minimize gastrointestinal intolerance and enhance absorption of clavulanic acid 1
• For children with renal impairment:
  • GFR 10-30 mL/min: Reduce to every 12 hours
  • GFR <10 mL/min: Reduce to every 24 hours

Treatment Duration

• Standard treatment course for uncomplicated UTI: 5-7 days
• For complicated UTI or pyelonephritis: 10-14 days

Clinical Evidence

Research has demonstrated high efficacy of amoxicillin/clavulanic acid for pediatric UTIs, with studies showing:

• 96% clearance rate in first-time UTIs and 89% clearance in recurrent UTIs 2
• Effective against amoxicillin-resistant organisms due to the beta-lactamase inhibition by clavulanic acid 3

Common Pitfalls and Caveats

1. Tablet vs. Liquid Formulation Differences:

   • Do not substitute two 250/125 mg tablets for one 500/125 mg tablet, as they contain different amounts of clavulanic acid 1
   • Adult tablets have different amoxicillin/clavulanic acid ratios than pediatric formulations

2. Side Effects Management:

   • Gastrointestinal side effects occur in approximately 12% of cases 2
   • Taking with food at the start of a meal can reduce GI intolerance 1
   • If GI issues persist, consider spacing doses at 8-hour intervals rather than 12-hour intervals 2

3. Contraindications:

   • History of amoxicillin/clavulanic acid-associated jaundice/hepatic dysfunction
   • Known hypersensitivity to penicillins

4. Monitoring:

   • Assess clinical response within 48-72 hours
   • Signs of improvement include decreased fever, improved urinary symptoms, and better overall condition
   • Consider urine culture follow-up for complicated cases

Remember that while tablets are convenient for children who cannot take liquid formulations, they should only be used in children weighing at least 40 kg due to the specific amoxicillin/clavulanic acid ratio in the adult formulation.