What is the recommended dose of Augmentin (amoxicillin-clavulanate) for a 2-year-old child with sinusitis?

Augmentin Dosing for a 2-Year-Old with Sinusitis

For a 2-year-old child with sinusitis, high-dose amoxicillin-clavulanate (Augmentin) at 80-90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses (maximum 2g per dose) is recommended. 1

Rationale for High-Dose Augmentin in 2-Year-Olds

• Children younger than 2 years are at higher risk for harboring resistant organisms, making high-dose amoxicillin-clavulanate the preferred treatment 1
• The high-dose formulation effectively targets both β-lactamase-producing H. influenzae and M. catarrhalis as well as potentially resistant S. pneumoniae 1
• The potassium clavulanate component (6.4 mg/kg/day) provides adequate coverage against β-lactamase-producing pathogens 1

Dosing Schedule and Duration

• Administer the total daily dose in 2 divided doses 1
• Treatment should continue for 10-14 days 1
• Some guidelines suggest continuing treatment until 7 days after the patient becomes free of signs and symptoms 1

Alternative Options

• For children who cannot tolerate oral medication or who are vomiting, a single 50 mg/kg dose of ceftriaxone can be given intravenously or intramuscularly 1
• If clinical improvement is observed at 24 hours after ceftriaxone, an oral antibiotic can be substituted to complete the course 1
• For patients with penicillin allergy, second or third-generation cephalosporins may be considered, as recent evidence suggests the risk of cross-reactivity is minimal 1, 2

Monitoring Response to Treatment

• Assess clinical improvement at 3-5 days after starting treatment 1
• If no improvement is seen after 3-5 days, consider changing antibiotics or reevaluating the diagnosis 1
• Children who remain significantly febrile or symptomatic at 24 hours after parenteral therapy may require additional doses 1

Clinical Considerations and Cautions

• Risk factors for resistant organisms in this 2-year-old patient include:

  • Age younger than 2 years 1
  • Possible attendance at childcare 1
  • Recent antibiotic exposure (within previous 30 days) 1

• The high-dose amoxicillin component (80-90 mg/kg/day) achieves sinus fluid concentrations adequate to overcome resistance in S. pneumoniae 1

• Gastrointestinal side effects are the most common adverse events, but twice-daily dosing may improve tolerability compared to three-times-daily regimens 3