What is the recommended dose of Augmentin (amoxicillin and clavulanate) for a child with a dog bite?

Augmentin Dosing for Children with Dog Bites

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

Dosing Recommendations Based on Weight

• For children weighing <40 kg: 45 mg/kg/day divided every 12 hours 1, 2
• For children weighing ≥40 kg: Follow adult dosing of 875/125 mg twice daily 1, 2

Formulation Options

• For younger children: The 200 mg/5 mL or 400 mg/5 mL oral suspension is recommended 2
• For older children: Chewable tablets are available in appropriate strengths 2
• The high-dose formulation (Augmentin ES-600) provides a 14:1 ratio of amoxicillin to clavulanate, which is beneficial for more severe infections 3

Duration of Therapy

• Typically 5-7 days for uncomplicated dog bites 4
• May extend to 10-14 days for more severe infections, especially those involving bones or joints 4

Clinical Considerations

Indications for Antibiotic Prophylaxis

• Moderate to severe injuries 1
• Puncture wounds 1, 5
• Wounds to the hand, face, or feet 1, 5
• Immunocompromised patients 1
• Patients with asplenia or advanced liver disease 1
• Wounds with existing or resultant edema 1
• Injuries that may have penetrated periosteum or joint capsule 1

Rationale for Amoxicillin-Clavulanate

• First-line treatment due to coverage against common pathogens in dog bites: 4, 6
  • Pasteurella multocida (found in 50% of dog bite wounds) 4
  • Staphylococcus aureus and Streptococcus species (found in ~40% of bites) 4
  • Anaerobic bacteria including Bacteroides species, fusobacteria, and others 4
  • Beta-lactamase producing organisms 7

Alternative Antibiotics for Penicillin-Allergic Patients

• Doxycycline (for children >8 years) 4
• Fluoroquinolones plus metronidazole (for adolescents) 4
• Clindamycin plus trimethoprim-sulfamethoxazole 1

Wound Management

• Cleanse thoroughly with sterile normal saline 4
• Remove superficial debris 4
• Consider tetanus prophylaxis if vaccination not current within past 10 years 1
• Evaluate for potential complications such as septic arthritis, osteomyelitis, or tendonitis 4

Monitoring and Follow-up

• Evaluate response to treatment within 48-72 hours 1
• If no improvement or worsening occurs after 72 hours, consider alternative antibiotics or reevaluation 1
• Watch for potential complications, especially with hand wounds which are often more serious than wounds to fleshy parts of the body 4

Common Pitfalls to Avoid

• Avoid first-generation cephalosporins (e.g., cephalexin), penicillinase-resistant penicillins (e.g., dicloxacillin), macrolides (e.g., erythromycin), and clindamycin alone, as they have poor activity against P. multocida 4
• Do not delay antibiotic treatment for puncture wounds or bites to high-risk areas 5
• Ensure proper dosing based on weight; children ≥40 kg should receive adult dosing 1, 2
• Administer at the start of a meal to minimize gastrointestinal intolerance 2