What is the appropriate dosage of Augmentin (amoxicillin/clavulanate) for a 20.46 kg patient with otitis?

Augmentin Dosage for Otitis Media in a 20.46 kg Child

For a 20.46 kg child with otitis media, the recommended dosage of Augmentin (amoxicillin/clavulanate) is 90 mg/6.4 mg per kg per day in two divided doses for 10 days. 1

Dosage Calculation

• For a 20.46 kg child:
  • Total daily amoxicillin dose: 90 mg/kg × 20.46 kg = 1,841.4 mg per day 1
  • This should be divided into two equal doses of approximately 920 mg per dose 2
  • The high-dose formulation (90/6.4 mg/kg/day) is preferred over standard dosing (40/10 mg/kg/day) for otitis media due to better coverage against resistant pathogens 3

Rationale for High-Dose Formulation

• High-dose amoxicillin/clavulanate is recommended for otitis media because:
  • It provides superior coverage against penicillin-resistant Streptococcus pneumoniae 2
  • It has excellent efficacy against Haemophilus influenzae and Moraxella catarrhalis 3
  • Studies show 98% eradication rate for S. pneumoniae, including 91% of penicillin-resistant strains 2

Duration of Treatment

• Complete a full 10-day course of treatment 1
• Twice-daily dosing has been shown to be as effective as three-times-daily dosing, which improves compliance 4

Monitoring and Follow-up

• Assess clinical response after 72 hours of therapy 1
• If no improvement or worsening after 72 hours, consider:
  • Switching to alternative therapy such as ceftriaxone 1
  • Reevaluating the patient for complications or alternative diagnoses 1

Common Pitfalls and Caveats

• Underdosing is a common error - ensure the full 90 mg/kg/day of the amoxicillin component is administered 3
• Do not use standard adult dosing for children, as weight-based dosing is essential 1
• Be aware that diarrhea is a common side effect, but is generally less frequent with twice-daily dosing compared to three-times-daily dosing 3
• For patients with penicillin allergy, alternative therapies should be considered (cephalosporins if non-Type I reaction, or macrolides if Type I reaction) 1

Special Considerations

• If the patient has received antibiotics in the previous 4-6 weeks, high-dose amoxicillin/clavulanate is particularly important to overcome potential resistant organisms 1
• For severe cases or treatment failures, parenteral therapy with ceftriaxone (50 mg/kg/day) may be considered 1