Recommended Dosage of Augmentin for Children
For children, the recommended dosage of Augmentin (amoxicillin/clavulanate) is 45 mg/kg/day of the amoxicillin component in divided doses every 12 hours for mild to moderate infections, and 90 mg/kg/day in divided doses every 12 hours for severe infections. 1
Standard Dosing Regimens
Mild to Moderate Infections
- Standard dose: 45 mg/kg/day of amoxicillin component
- Administration: Divided into 2 doses (every 12 hours)
- Indications: Ear, nose, throat, skin, and genitourinary tract infections 2
Severe Infections
- High dose: 90 mg/kg/day of amoxicillin component
- Administration: Divided into 2 doses (every 12 hours)
- Indications: 1, 3
- Lower respiratory tract infections
- Suspected drug-resistant pathogens
- Recent antibiotic use (within past 30 days)
- Children attending daycare
- Children under 2 years of age
Formulations
Augmentin is available in several formulations for pediatric use:
- Standard formulation: 7:1 ratio of amoxicillin to clavulanate
- High-dose formulation (Augmentin ES-600): 14:1 ratio of amoxicillin to clavulanate 4
The high-dose formulation allows for increased amoxicillin dosing without increasing clavulanate, which helps reduce gastrointestinal side effects while maintaining efficacy against resistant pathogens 5.
Age-Specific Considerations
Children Under 3 Months (12 weeks)
- Due to incompletely developed renal function, the recommended upper dose is 30 mg/kg/day divided every 12 hours 2
Children 3 Months and Older
- Follow standard dosing guidelines based on infection severity
- Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 2
- For Streptococcus pyogenes infections, treatment should continue for at least 10 days to prevent acute rheumatic fever 2
Clinical Pearls and Precautions
Administration Tips
- Administer at the start of a meal to minimize gastrointestinal intolerance 2
- Shake oral suspension well before using
- Refrigeration of reconstituted suspension is preferable but not required 2
- Discard unused portion after 14 days 2
Common Pitfalls to Avoid
- Underdosing: Using standard dose for severe infections or when resistant pathogens are suspected
- Improper administration: Not giving with food, which can increase GI side effects
- Inadequate duration: Stopping therapy too soon after symptom resolution
- Improper storage: Not refrigerating reconstituted suspension
Monitoring
- Assess for treatment failure, defined as development of lower chest-wall indrawing, central cyanosis, stridor, or persistently raised respiratory rate at 72 hours 3
- Monitor for common adverse effects, primarily mild gastrointestinal disturbances such as diarrhea 6
Evidence Quality and Considerations
The twice-daily dosing regimen has shown equivalent efficacy to three-times-daily dosing with potentially better compliance and fewer side effects 7. The high-dose formulation (90 mg/kg/day) has demonstrated effectiveness against penicillin-resistant Streptococcus pneumoniae and is recommended for recurrent or persistent infections 6, 5.
For children with impaired renal function, dosage adjustment may be necessary if impairment is severe 2.