Maximum Dose of Augmentin for Strep Throat in Children
For children with Group A Streptococcal pharyngitis, the maximum dose of amoxicillin/clavulanate (Augmentin) is 40 mg/kg/day of the amoxicillin component, divided into three doses, with a maximum daily dose of 2,000 mg amoxicillin. 1
First-Line Treatment Options for Strep Throat
- Amoxicillin alone is the preferred first-line treatment for Group A Streptococcal pharyngitis in children at a dose of 50 mg/kg once daily (maximum 1,000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1
- Penicillin V is an alternative first-line option at 50-75 mg/kg/day in 3 or 4 doses for 10 days 1
When to Use Augmentin (Amoxicillin/Clavulanate)
Augmentin is not typically a first-line agent for uncomplicated strep throat but may be indicated in specific scenarios:
- For chronic carriers of Group A Streptococcus who have failed first-line therapy 1
- When beta-lactamase producing organisms are suspected as co-pathogens 2, 3
- For recurrent strep throat infections 4
Dosing Guidelines for Augmentin in Children with Strep Throat
- Standard dosing: 40 mg amoxicillin/kg/day divided into three doses (maximum 2,000 mg amoxicillin per day) for 10 days 1
- This dosing has a strong recommendation with moderate-quality evidence 1
- Treatment should be continued for a minimum of 10 days to prevent acute rheumatic fever 5
Alternative Formulations and Dosing Schedules
- Twice-daily formulation: 45/6.4 mg/kg/day of amoxicillin/clavulanate in two divided doses may improve compliance while maintaining efficacy 6
- High-dose formulation (Augmentin ES-600): 90/6.4 mg/kg/day in two divided doses is primarily indicated for resistant otitis media, not routine strep throat treatment 3, 4
Treatment Considerations
- For children with penicillin allergy, alternative options include cephalexin (if no immediate hypersensitivity), clindamycin, or macrolides 1
- Compliance may be better with twice-daily dosing compared to three-times-daily regimens 6
- Monitor for common side effects, primarily gastrointestinal disturbances such as diarrhea 3, 6
Important Cautions
- Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance 5
- For patients with severe renal impairment (GFR <30 mL/min), dose adjustment is required 5
- Avoid the 875 mg dose in patients with severe renal impairment 5
Remember that while Augmentin is effective against strep throat, it has a broader spectrum than necessary for most cases of Group A Streptococcal pharyngitis, and amoxicillin alone remains the first-line treatment to reduce unnecessary antibiotic exposure and potential resistance development 1, 7.