Maximum Dose of Augmentin for Children
The maximum recommended dose of Augmentin (amoxicillin/clavulanate) for children is 90 mg/kg/day of the amoxicillin component, with a maximum daily dose of 4000 mg (4 g) per day for severe infections. 1
Dosing Guidelines Based on Age and Weight
For Children Aged 3 Months and Older
- For mild to moderate infections: 45 mg/kg/day of the amoxicillin component divided every 12 hours 2
- For severe infections or in areas with high pneumococcal resistance: 90 mg/kg/day of the amoxicillin component divided every 12 hours 1, 2
- For β-lactamase producing organisms (like H. influenzae): amoxicillin/clavulanate with amoxicillin component at 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses 3
For Infants Less Than 12 Weeks (3 Months)
- Maximum recommended dose: 30 mg/kg/day divided every 12 hours, based on the amoxicillin component 2, 4
- This lower dosing is due to incompletely developed renal function affecting elimination of amoxicillin in this age group 4
Formulation Considerations
- The 200 mg/5 mL or 400 mg/5 mL oral suspension is recommended for the every 12-hour dosing regimen 2
- The twice-daily regimen is preferred as it is associated with significantly less diarrhea than three-times-daily dosing 2, 5
- For children weighing 40 kg or more, adult dosing recommendations should be followed 2
Indication-Specific Dosing
- For respiratory tract infections (pneumonia): 45 mg/kg/day in 2 doses for mild to moderate infections; 90 mg/kg/day in 2 doses for severe infections 3, 1
- For recurrent or persistent acute otitis media: high-dose amoxicillin/clavulanate (90 mg/kg/day of amoxicillin component) is recommended, especially in areas with high pneumococcal resistance 6, 7
- For community-acquired pneumonia with β-lactamase producing organisms: amoxicillin/clavulanate with amoxicillin component at 90 mg/kg/day in 2 doses 3, 1
Important Administration Considerations
- To minimize gastrointestinal intolerance, Augmentin should be taken at the start of a meal 2, 4
- Treatment duration typically ranges from 7-10 days depending on the infection 1
- For infections caused by Streptococcus pyogenes, a minimum of 10 days treatment is recommended to prevent acute rheumatic fever 4
Special Considerations
- For children with renal impairment (GFR <30 mL/min), the 875 mg/125 mg dose should NOT be used 2, 4
- Dosing should be adjusted based on the severity of infection and local patterns of antimicrobial resistance 1
- The high-dose formulation (600 mg of amoxicillin per 5 mL) provides a 14:1 ratio of amoxicillin to clavulanate, which is designed to provide adequate coverage against resistant pathogens while minimizing gastrointestinal side effects 7
By following these dosing guidelines, clinicians can optimize treatment outcomes while minimizing the risk of adverse effects in pediatric patients requiring Augmentin therapy.