Pediatric Dosing of Augmentin for Dental Infections
For pediatric dental infections, the recommended dose of amoxicillin-clavulanate (Augmentin) is 45 mg/kg/day divided every 12 hours for moderate to severe infections, with a maximum of 875/125 mg twice daily for children weighing ≥40 kg. 1
Dosing Guidelines Based on Age and Weight
- For children aged 3 months and older with dental infections, the standard dosing regimen is 45 mg/kg/day divided every 12 hours based on the amoxicillin component 2
- For more severe dental infections, the dose may be increased to 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate (in a 14:1 ratio) divided into two doses 3
- Children weighing 40 kg or more should follow adult dosing: 875/125 mg twice daily 2, 1
- Neonates and infants under 12 weeks should receive 30 mg/kg/day divided every 12 hours, though dental infections are rare in this age group 2
Clinical Considerations for Dental Infections
- Amoxicillin-clavulanate is the preferred antibiotic for dental infections because it provides coverage against common oral pathogens, including gram-positive anaerobes, facultative bacteria, and beta-lactamase producing organisms 4
- For odontogenic infections (acute dento-alveolar abscess), amoxicillin-clavulanate should be used as a second-line agent if there is no improvement within 2-3 days of treatment with amoxicillin alone 4
- Antibiotic therapy should always be accompanied by appropriate dental interventions such as drainage of abscesses, debridement of root canals, or scaling and root planing for periodontal infections 4
Duration of Therapy
- The typical duration of therapy for uncomplicated dental infections is 5-7 days 1
- For more severe infections, especially those involving bones or joints, treatment may be extended to 10-14 days 1
Alternative Options for Penicillin-Allergic Patients
- For children with immediate Type I hypersensitivity reactions to penicillins, clindamycin is the preferred alternative at a dose of 30-40 mg/kg/day in 3 divided doses 3, 1
- Cephalosporins (cefdinir, cefuroxime, cefpodoxime) may be used in patients with non-immediate penicillin allergies, as cross-reactivity is lower than historically reported 3
- For beta-lactam allergic patients with periodontal infections, macrolides may be considered, though they have limited effectiveness against some oral pathogens 4
Administration Considerations
- Augmentin should be administered at the start of a meal to minimize gastrointestinal intolerance 2
- The twice-daily regimen is recommended as it is associated with significantly less diarrhea than three-times-daily dosing 2, 5
- For improved compliance and tolerability, the 14:1 ratio formulation (high-dose amoxicillin with standard clavulanate) is preferred for pediatric patients 6
Common Pitfalls to Avoid
- Do not use first-generation cephalosporins, penicillinase-resistant penicillins, or macrolides alone for dental infections as they have poor activity against many oral pathogens 1
- Avoid using antibiotics without appropriate dental interventions, as antibiotics alone are insufficient for treating dental infections 4
- Monitor for gastrointestinal side effects, which are the most common adverse events in children receiving amoxicillin-clavulanate 5
Remember that antibiotic therapy for dental infections should always be accompanied by appropriate dental interventions to address the source of infection.