What is the recommended dose of co-amoxiclav (amoxicillin-clavulanic acid) for a 10-month-old pediatric patient?

Co-amoxiclav Dosing for a 10-Month-Old Pediatric Patient

For a 10-month-old pediatric patient, the recommended dose of co-amoxiclav (amoxicillin-clavulanic acid) is 2.5 ml/kg of 125/31 suspension three times daily. 1

Dosing Guidelines Based on Age and Weight

• For children under 1 year of age (including 10-month-olds), the appropriate dose is 2.5 ml/kg of 125/31 suspension three times daily 1
• For infants less than 12 weeks (3 months), the upper limit of amoxicillin dosing is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2
• For children 3 months and older but weighing less than 40 kg, the FDA recommends dosing based on severity of infection 2:
  • For mild/moderate infections: 25 mg/kg/day of amoxicillin component divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
  • For severe infections: 45 mg/kg/day of amoxicillin component divided every 12 hours or 40 mg/kg/day divided every 8 hours 2

Formulation Considerations

• Co-amoxiclav is available as an oral suspension with different ratios of amoxicillin to clavulanic acid 3
• The 125/31 suspension contains 125 mg amoxicillin and 31 mg clavulanic acid per 5 ml 1
• The suspension should be shaken well before use and can be administered directly or mixed with formula, milk, fruit juice, or water 2
• To minimize gastrointestinal intolerance, co-amoxiclav should be taken at the start of a meal 2, 3

Duration of Treatment

• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 2
• For infections caused by Streptococcus pyogenes, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 2
• Children on adequate therapy should demonstrate clinical improvement within 48-72 hours 4

Special Considerations for Respiratory Infections

• For respiratory tract infections, particularly those involving β-lactamase producing H. influenzae, amoxicillin-clavulanate at 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses may be recommended 5
• In areas with high prevalence of penicillin-resistant Streptococcus pneumoniae, higher dosing may be warranted 5

Potential Adverse Effects

• The most common adverse effects include gastrointestinal disturbances such as diarrhea, which is more common with amoxicillin-clavulanate than with some other antibiotics 1, 6
• Rash, urticaria, and other hypersensitivity reactions may occur 1
• Monitoring for signs of allergic reaction is important, especially with the first few doses 1
• Diarrhea is generally less frequent with twice-daily than with three-times-daily treatment 6

Clinical Monitoring

• Monitor for clinical improvement within 48-72 hours of starting therapy 4
• If the child's condition deteriorates after starting therapy or shows no improvement within 48-72 hours, further investigation should be performed 4
• Any unused portion of the reconstituted suspension must be discarded after 14 days 2

Practical Administration Tips

• After reconstitution, the required amount of suspension can be placed directly on the child's tongue or mixed with formula, milk, or juice 2
• These preparations should be taken immediately after mixing 2
• Refrigeration of the reconstituted suspension is preferable but not required 2