Amoxicillin-Clavulanate Dosing for a 16.5kg Child with Otitis Media
For a 16.5kg child with otitis media, the recommended dose of amoxicillin-clavulanate 125/5 is 90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate, given in 2 divided doses. 1, 2
Dosage Calculation
- For a 16.5kg child, the total daily amoxicillin dose would be: 90 mg/kg/day × 16.5kg = 1,485 mg/day 1, 2
- This should be divided into two doses: 742.5 mg per dose, given twice daily 1, 2
- The clavulanate component would be: 6.4 mg/kg/day × 16.5kg = 105.6 mg/day total, or approximately 52.8 mg per dose 1
Rationale for High-Dose Amoxicillin-Clavulanate
- High-dose amoxicillin-clavulanate is recommended for children who have taken amoxicillin in the previous 30 days, those with concurrent conjunctivitis, or those for whom coverage for β-lactamase–positive H. influenzae and M. catarrhalis is desired 1, 2
- The 14:1 ratio of amoxicillin to clavulanate is preferred as it is less likely to cause diarrhea than other amoxicillin-clavulanate preparations 1, 3
- High-dose formulation achieves middle ear fluid levels that exceed the minimum inhibitory concentration of intermediately resistant and many highly resistant S. pneumoniae serotypes 1, 4
Administration Considerations
- The medication should be given in two divided doses rather than three times daily, as this has been shown to have similar efficacy with better compliance and significantly lower rates of diarrhea 3, 5, 6
- A twice-daily regimen has demonstrated comparable bacteriological and clinical efficacy to three-times-daily dosing 5, 6
- The incidence of diarrhea was significantly lower in patients who received the every 12 hours regimen compared to patients who received the every 8 hours regimen (14% vs. 34%) 3
Treatment Duration
- The recommended duration of therapy for acute otitis media is 10 days 3, 2
- Clinical efficacy rates at the end of therapy (defined as 2-4 days after completion) have been shown to be 87% for twice-daily dosing 3
Alternative Options
- If the child has a penicillin allergy, alternative treatments include cefdinir (14 mg/kg/day in 1 or 2 doses), cefuroxime (30 mg/kg/day in 2 divided doses), or cefpodoxime (10 mg/kg/day in 2 divided doses) 1, 2
- If initial treatment fails after 48-72 hours, ceftriaxone (50 mg IM or IV for 3 days) may be considered 1, 2
Clinical Pearls and Pitfalls
- Always verify the specific formulation of amoxicillin-clavulanate being used, as different products have different ratios of amoxicillin to clavulanate 3
- Do not substitute two 250mg/125mg tablets for one 500mg/125mg tablet, as they contain different amounts of clavulanic acid 3
- Monitor for diarrhea, which is the most common adverse effect of amoxicillin-clavulanate therapy 3, 7
- Ensure the caregiver understands the importance of completing the full course of antibiotics even if symptoms improve before completion 2