Pediatric Augmentin Dosage for Animal Bites
For pediatric patients with animal bites, amoxicillin-clavulanate (Augmentin) should be administered at a dose of 25 mg/kg/day of the amoxicillin component in 2 divided doses orally. 1
Rationale for Amoxicillin-Clavulanate Selection
- Amoxicillin-clavulanate is the first-line antibiotic for animal bite prophylaxis and treatment due to its excellent coverage against the polymicrobial nature of animal bite wounds 1, 2
- Animal bites typically contain multiple aerobic and anaerobic bacteria, including Pasteurella multocida (present in >50% of cat bites and 20-30% of dog bites), Staphylococcus aureus, Bacteroides species, and various anaerobes 1, 3
- The addition of clavulanic acid to amoxicillin provides protection against beta-lactamase producing organisms commonly found in animal bites 4
Dosing Guidelines for Pediatric Patients
Standard Dosing:
- For most pediatric patients: 25 mg/kg/day of the amoxicillin component divided into 2 doses per day 1
- This dosage is based on the standard formulation with a 7:1 ratio of amoxicillin to clavulanate 4
Alternative Dosing Options:
- For more severe infections or cases with concern for resistant organisms: 45 mg/kg/day in divided doses 5
- For very severe infections: Consider the high-dose formulation (Augmentin ES-600) at 90 mg/kg/day of amoxicillin component in 2 divided doses 6
Duration of Therapy
- For prophylaxis of clean animal bite wounds: 3-5 days 1
- For established infections or higher-risk wounds: 7-10 days 1, 2
Special Considerations
- For cat bites, which have a higher infection risk than dog bites, ensure adequate duration of therapy (minimum 5 days) 2, 3
- For puncture wounds, especially to the hand, consider a longer duration of therapy (7-10 days) 2
- For immunocompromised patients, use the higher end of the dosing range and longer duration 2
Alternative Antibiotics for Penicillin-Allergic Patients
- For patients with non-severe penicillin allergy: Cefuroxime (30 mg/kg/day divided into 2 doses) 1
- For patients with severe penicillin allergy: Clindamycin (10-20 mg/kg/day in 3 divided doses) plus trimethoprim-sulfamethoxazole (8-12 mg/kg/day based on trimethoprim component in 2 divided doses) 1
- For children >8 years with severe penicillin allergy: Doxycycline (100 mg twice daily) may be considered 1
Common Pitfalls to Avoid
- Underdosing amoxicillin-clavulanate can lead to treatment failure, especially with resistant organisms 4
- Delaying antibiotic therapy beyond 8 hours after the bite increases infection risk substantially 2
- Failing to consider rabies prophylaxis when indicated (even for domestic animal bites if vaccination status is unknown) 2
- Not recognizing that hand bites, especially cat bites to the hand, have significantly higher infection rates and may require more aggressive therapy 3
By following these evidence-based recommendations, clinicians can effectively manage pediatric patients with animal bites while minimizing complications and optimizing outcomes.