What is the maximum dose of Augmentin (amoxicillin/clavulanate) for pediatric patients?

Maximum Dose of Augmentin (Amoxicillin/Clavulanate) for Pediatric Patients

The maximum dose of Augmentin (amoxicillin/clavulanate) for pediatric patients is 90 mg/kg/day of the amoxicillin component, with a maximum daily dose of 4000 mg (4 g) per day. 1, 2

Dosing Guidelines by Age and Weight

Children weighing less than 40 kg:

• Mild to moderate infections:

  • 45 mg/kg/day of amoxicillin component divided into two doses (every 12 hours) 1
  • Alternative: 40 mg/kg/day divided into three doses (every 8 hours) 1

• Severe infections (including respiratory tract infections in areas with high pneumococcal resistance):

  • 90 mg/kg/day of amoxicillin component divided into two doses (every 12 hours) 2
  • Alternative: 90 mg/kg/day divided into three doses 2

Children weighing 40 kg or more:

• Maximum daily dose: 4000 mg (4 g) of amoxicillin component per day 1
• Typically administered as 875 mg every 12 hours or 500 mg every 8 hours 1

Infants less than 12 weeks (3 months) old:

• Maximum recommended dose: 30 mg/kg/day divided every 12 hours 1
• This lower dosage is due to incompletely developed renal function affecting amoxicillin elimination 1

Formulation Considerations

Different formulations of Augmentin provide different ratios of amoxicillin to clavulanate:

• Standard formulation: 4:1 ratio 3
• High-dose formulation (Augmentin ES-600): 14:1 ratio, providing 90 mg/kg/day of amoxicillin component while maintaining the same daily dose of clavulanate as regular strength formulation 3, 4

Dosing for Specific Conditions

For Respiratory Tract Infections:

• Community-acquired pneumonia: 90 mg/kg/day of amoxicillin component in 2 doses 2
• For β-lactamase producing H. influenzae: Amoxicillin/clavulanate with amoxicillin component at 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses 2

For Otitis Media:

• Recurrent or persistent cases: High-dose amoxicillin/clavulanate (90/6.4 mg/kg/day) in two divided doses 4, 3

Administration Recommendations

• Administer at the start of a meal to minimize gastrointestinal intolerance 1
• Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 1
• For Streptococcus pyogenes infections, treatment should continue for at least 10 days to prevent acute rheumatic fever 1

Safety Considerations and Adverse Effects

• Most common adverse effects are mild gastrointestinal disturbances, particularly diarrhea 5, 6
• Twice-daily dosing may result in fewer gastrointestinal side effects than three-times-daily dosing 6
• Patients with severe renal impairment (GFR <30 mL/min) should NOT receive the 875 mg dose 1

Clinical Pearls

• The high-dose formulation was developed specifically to address drug-resistant Streptococcus pneumoniae while maintaining a favorable safety profile 4, 3
• Compliance is generally better with twice-daily dosing compared to three-times-daily dosing (82.8% vs. 73.3%) 6
• After reconstitution, oral suspension must be discarded after 14 days 1

Remember that dosing should be adjusted based on the severity of infection and local patterns of antimicrobial resistance, particularly for pneumococcal resistance 2, 7.