What is the recommended dosage of co-amoxiclav (amoxicillin/clavulanic acid) for an 11kg pediatric patient with a boil?

Co-amoxiclav Dosage for an 11kg Pediatric Patient with a Boil

For an 11kg pediatric patient with a boil, the recommended dosage of co-amoxiclav is 0.266 ml/kg of 125/31 suspension three times daily, which equals approximately 3 ml three times daily for 7-10 days. 1

Dosage Calculation

• For children from birth to 1 year, the British Thoracic Society guidelines recommend co-amoxiclav at a dose of 0.266 ml/kg of the 125/31 suspension three times daily 1
• For an 11kg child, this calculates to approximately 3 ml of the 125/31 suspension three times daily 1
• In cases of severe infections, the dose may be doubled according to the guidelines 1
• The recommended duration of treatment is 7-10 days, which may be extended to 14 days depending on clinical response 1

Rationale for Co-amoxiclav in Skin Infections

• Co-amoxiclav is effective against Staphylococcus aureus, the most common pathogen in boils, as it combines amoxicillin with clavulanic acid to overcome β-lactamase producing organisms 1
• The addition of clavulanate preserves the activity of amoxicillin in the presence of β-lactamases, making it effective against skin infections where β-lactamase producing organisms are common 1

Alternative Dosing Considerations

• For children 1-6 years old, an alternative fixed dosing of 5 ml of 125/31 suspension three times daily can be used 1
• Some evidence suggests twice-daily dosing may be as effective as three times daily dosing and could improve compliance 2
• However, for skin infections like boils where adequate antimicrobial coverage is essential, the standard three times daily regimen is preferred to maintain consistent blood levels 1

Special Considerations

• If the boil is large, fluctuant, or accompanied by significant surrounding cellulitis, consider:
  • Incision and drainage as the primary treatment 1
  • Potentially doubling the dose in severe infections as mentioned in the guidelines 1
• Monitor for clinical improvement within 48-72 hours; if no improvement is seen, reassess the diagnosis and consider changing the antimicrobial agent 1

Potential Adverse Effects

• The most common adverse effects are mild gastrointestinal disturbances 3
• Diarrhea is generally less frequent with twice-daily than with three-times-daily treatment, but efficacy must be prioritized 3
• Monitor for signs of allergic reactions, which may necessitate discontinuation and alternative therapy 3

Common Pitfalls to Avoid

• Underdosing is a common error in pediatric prescribing; ensure accurate weight-based calculations 1
• Failure to complete the full course of antibiotics may lead to treatment failure and potential resistance 1
• Not considering drainage for fluctuant boils - remember that antibiotics alone may be insufficient for abscesses that require drainage 1