What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 2-year-old child weighing 13kg with streptococcal infection?

Augmentin Dosing for Streptococcal Infection in a 2-Year-Old Child Weighing 13kg

For a 2-year-old child weighing 13kg with streptococcal infection, the recommended dose of Augmentin (amoxicillin/clavulanate) is 45 mg/kg/day divided into two doses, which equals approximately 300 mg twice daily of the amoxicillin component for 10 days.

Dosage Calculation

The appropriate dosing for streptococcal infections should be based on the following considerations:

• For streptococcal infections, particularly those affecting the respiratory tract, the FDA-approved dosing for children is 45 mg/kg/day of the amoxicillin component divided into two doses for severe infections 1
• For a 13kg child, this equals: 13kg × 45 mg/kg/day = 585 mg/day
• Divided into two doses: approximately 290-300 mg twice daily

Formulation Selection

The appropriate formulation would be:

• Augmentin oral suspension 400mg/57mg per 5mL (most common pediatric formulation)
• Dosage: 3.75 mL twice daily

Duration of Treatment

• A full 10-day course is mandatory for streptococcal infections to prevent complications such as acute rheumatic fever 2, 1
• The FDA label specifically states: "It is recommended that there be at least 10 days' treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever" 1

Important Clinical Considerations

Efficacy and Coverage

• Augmentin provides coverage against both streptococci and potential beta-lactamase producing organisms that might be present in mixed infections 3
• For streptococcal pharyngitis specifically, amoxicillin alone would be sufficient, but Augmentin may be preferred if there's concern about mixed infection or beta-lactamase producing organisms 4

Administration Guidelines

• Administer at the start of a meal to minimize gastrointestinal intolerance 1
• Shake oral suspension well before using 1
• Complete the full 10-day course even if symptoms improve before completion 2

Monitoring and Follow-up

• Monitor for common side effects: diarrhea (most common), diaper rash, and other gastrointestinal disturbances 5
• If severe diarrhea occurs, consider probiotic supplementation but continue the antibiotic course if possible

Alternative Options

If the child cannot tolerate Augmentin due to gastrointestinal side effects, alternative options include:

• Cefaclor: 40 mg/kg/day in three divided doses (approximately 170 mg three times daily) 4
• Clindamycin: 30-40 mg/kg/day in three divided doses for penicillin-allergic patients 4

Common Pitfalls to Avoid

1. Underdosing: Using insufficient doses (e.g., 40 mg/kg/day instead of 45 mg/kg/day) for streptococcal infections may lead to treatment failure
2. Incorrect duration: Stopping therapy before 10 days significantly increases the risk of rheumatic fever
3. Poor timing with meals: Administering on an empty stomach increases GI side effects
4. Improper storage: Reconstituted suspension must be refrigerated and discarded after 14 days

Remember that completing the full 10-day course is critical even if symptoms resolve earlier, as this is essential for preventing serious complications of streptococcal infections.