What is the appropriate dosage of Augmentin (amoxicillin-clavulanate) for a pediatric patient with a dog bite?

Appropriate Dosage of Augmentin for Pediatric Dog Bite

For pediatric patients with dog bites, amoxicillin-clavulanate (Augmentin) should be dosed at 45 mg/kg/day divided every 12 hours for moderate to severe injuries, especially those to the hand or face. 1, 2

Dosing Recommendations

Based on Age and Weight

• Infants aged <12 weeks (<3 months):

  • 30 mg/kg/day divided every 12 hours (based on amoxicillin component) 1
  • 125 mg/5 mL oral suspension is recommended for this age group 1

• Children aged ≥12 weeks (≥3 months):

  • Moderate to severe infections: 45 mg/kg/day divided every 12 hours 1, 2
  • Less severe infections: 25 mg/kg/day divided every 12 hours 1
  • The every 12-hour regimen is preferred as it is associated with significantly less diarrhea 1

• Children weighing ≥40 kg:

  • Follow adult dosing: 875/125 mg twice daily 1, 2

Duration of Therapy

• 3-5 days of treatment is recommended for dog bite wounds 2

Clinical Decision Making

Indications for Antibiotic Therapy

Preemptive antimicrobial therapy is recommended for pediatric patients with dog bites who have:

• Moderate to severe injuries, especially to the hand or face 2
• Puncture wounds 2
• Immunocompromised status 2
• Asplenia 2
• Advanced liver disease 2
• Preexisting or resultant edema of the affected area 2
• Injuries that may have penetrated the periosteum or joint capsule 2
• Presentation >9 hours after the bite 2

Rationale for Amoxicillin-Clavulanate

Amoxicillin-clavulanate is the first-line treatment because it provides coverage against:

• Pasteurella multocida (common in dog bites) 2, 3
• Staphylococcus aureus 2
• Streptococcus species 2
• Eikenella corrodens 2
• Anaerobic bacteria (Fusobacterium, Porphyromonas, Prevotella species) 2

Special Considerations

Wound Management

• Primary repair of pediatric facial dog bite injuries is safe when performed in conjunction with antibiotic administration 4
• Copious irrigation and cautious debridement are recommended for facial wounds 2

Tetanus Prophylaxis

• Tetanus toxoid should be administered if the child has not received vaccination within the past 10 years 2
• Tdap (Tetanus, diphtheria, and pertussis) is preferred over Td if the former has not been previously given 2

Alternative Antibiotics for Penicillin-Allergic Patients

For patients with penicillin allergy:

• Non-severe allergy: Cefuroxime (500 mg twice daily for adults; weight-based dosing for children) 2
• Severe/immediate hypersensitivity: Clindamycin (10-20 mg/kg/day in 3 divided doses) plus either trimethoprim-sulfamethoxazole or a fluoroquinolone (in children >8 years) 2

Monitoring and Follow-up

• Evaluate response to treatment within 48-72 hours 2
• If no improvement or worsening after 72 hours, consider alternative antibiotics or reevaluation 2

Common Pitfalls to Avoid

• Underdosing: Using standard amoxicillin-clavulanate dosing rather than the higher dose recommended for moderate to severe infections 1, 5
• Inadequate coverage: Using antibiotics that don't cover Pasteurella multocida (such as first-generation cephalosporins or clindamycin alone) 2, 3
• Delayed treatment: Waiting for signs of infection before initiating antibiotics in high-risk bites 2
• Incomplete documentation: Failing to document dog breed and circumstances of bite, which is important for both medical and public health purposes 6

The incidence of pediatric dog bites has increased by 25% over a 10-year period, with craniofacial injuries being most common, highlighting the importance of appropriate antibiotic prophylaxis in these cases 6.