Recommended Dosage of Augmentin (Amoxicillin/Clavulanate) for Children
For children requiring amoxicillin/clavulanate (Augmentin), the recommended dosage is 45 mg/kg/day of the amoxicillin component in standard cases, or 80-90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate in two divided doses for more severe infections or high-risk patients. 1
Standard Dosing Regimens
Standard-Dose Regimen
- Mild to moderate infections: 45 mg/kg/day of amoxicillin component divided into 2 doses 1
- Administered every 12 hours
- Maximum dose: 2 g per dose 1
High-Dose Regimen
- Moderate to severe infections: 80-90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate divided into 2 doses 1, 2
- For children who are:
- Younger than 2 years
- Attending childcare
- Recently treated with antibiotics (within previous 30 days)
- In areas with high prevalence of resistant organisms
- Maximum dose: 2 g per dose 1
Risk Factors for Resistant Organisms
Children with the following risk factors should receive the high-dose regimen due to increased likelihood of resistant organisms:
- Age younger than 2 years 1
- Attendance at childcare 1
- Receipt of antimicrobial treatment within previous 30 days 1
- Living in communities with high prevalence of resistant S. pneumoniae (>10%) 1
Administration Guidelines
- Administer at the start of a meal to minimize gastrointestinal intolerance 3
- Shake oral suspension well before using 3
- After reconstitution, any unused portion must be discarded after 14 days 3
- Refrigeration is preferable but not required 3
Duration of Treatment
- Continue treatment for a minimum of 48-72 hours beyond symptom resolution 3
- For infections caused by Streptococcus pyogenes, treatment should continue for at least 10 days to prevent acute rheumatic fever 3
- For uncomplicated infections: 5-7 days 2
- For more severe infections: 10-14 days 2
Special Populations
Infants Under 3 Months (12 weeks)
- Due to incompletely developed renal function, the recommended upper dose is 30 mg/kg/day divided every 12 hours 3
Renal Impairment
- No dose reduction generally required unless impairment is severe 3
- For severe renal impairment (GFR <30 mL/min):
- Do NOT use the 875 mg dose
- Use 500 mg or 250 mg every 12 hours depending on infection severity 3
Formulation Options
Augmentin is available in several formulations with different ratios of amoxicillin to clavulanate:
- Original formulation: 4:1 ratio 4
- 7:1 ratio formulation 4
- High-dose formulation (Augmentin ES-600): 14:1 ratio (600 mg amoxicillin per 5 mL) 4
Monitoring and Follow-up
- Assess for clinical improvement within 48-72 hours 2
- Signs of improvement include:
- Decreased respiratory rate
- Reduced work of breathing
- Improved oxygen saturation
- Decreased fever
- Improved feeding 2
- If no improvement after 48 hours, consider switching to a second-line antibiotic 2
Common Side Effects and Management
- Gastrointestinal disturbances (most common) 5
- Diarrhea (less frequent with twice-daily than three-times-daily dosing) 5
- Mild skin reactions
Clinical Pearls
- The high-dose formulation was developed specifically to address drug-resistant S. pneumoniae while maintaining the same daily dose of clavulanic acid as regular formulations 4
- Twice-daily dosing has similar efficacy to three-times-daily dosing with better adherence 2
- For children with penicillin allergy, macrolides or other alternatives should be considered 2
- Avoid using broad-spectrum antibiotics when narrow-spectrum options would be effective 2