Recommended Dosage of Augmentin (Amoxicillin/Clavulanic Acid) in Pediatric Patients
The recommended dosage of Augmentin (amoxicillin/clavulanic acid) in pediatric patients varies based on indication, with standard dosing of 45 mg/kg/day of the amoxicillin component in 2 divided doses for mild to moderate infections, and high-dose therapy of 90 mg/kg/day in 2 divided doses for severe infections or in areas with high pneumococcal resistance. 1
Standard Dosing Recommendations
- For most pediatric infections, Augmentin should be dosed at 45 mg/kg/day of the amoxicillin component divided into 2 doses 1
- For β-lactamase producing organisms like H. influenzae, Augmentin with amoxicillin component at 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses is recommended 1
- The twice-daily dosing regimen has shown equivalent efficacy to three-times-daily dosing while improving compliance and reducing gastrointestinal side effects 2, 3
High-Dose Therapy
- For severe infections, including respiratory tract infections in areas with high pneumococcal resistance, the recommended dosage is 90 mg/kg/day of the amoxicillin component in 2 divided doses 1
- The maximum daily dose should not exceed 4000 mg (4 g) of the amoxicillin component per day 1
- High-dose formulation (Augmentin ES-600) provides a 14:1 ratio of amoxicillin to clavulanate, allowing for increased amoxicillin while maintaining the same daily dose of clavulanic acid 4
Dosing by Age Group
- For infants and children of all ages, dosing is primarily weight-based rather than age-based 5
- According to the Infectious Diseases Society of America guidelines, the following intravenous dosages are recommended for complicated intra-abdominal infections:
- Ampicillin-sulbactam: 200 mg/kg/day of ampicillin component, given every 6 hours 5
Duration of Therapy
- For respiratory infections, the typical treatment duration is 7-10 days 1
- For complicated intra-abdominal infections, duration varies based on the specific condition 5
Formulation Considerations
- Different formulations of Augmentin provide varying ratios of amoxicillin to clavulanic acid:
- Original formulation: 4:1 ratio
- Improved formulation: 7:1 ratio
- High-dose formulation (ES-600): 14:1 ratio 4
- The high-dose formulation was developed specifically to address increasing pneumococcal resistance while minimizing gastrointestinal side effects 6, 4
Adverse Effects and Monitoring
- The most common adverse effects are gastrointestinal disturbances, particularly diarrhea 1, 3
- Twice-daily dosing has been shown to reduce the incidence of diarrhea compared to three-times-daily dosing (9.6% vs 26.7%) 3
- Hypersensitivity reactions including rash and urticaria may occur 1
Clinical Pearls
- When treating recurrent or persistent acute otitis media after failure of amoxicillin alone, high-dose amoxicillin/clavulanate is considered a treatment of choice 6
- For children with severe reactions to β-lactam antibiotics, alternative antibiotic classes should be considered 5
- Dosing should be adjusted based on local patterns of antimicrobial resistance, particularly for pneumococcal resistance 1