Pediatric Augmentin (Amoxicillin-Clavulanate) Dosing Guidelines
For pediatric patients, the recommended dosage of Augmentin (amoxicillin-clavulanate) is 45 mg/kg/day of the amoxicillin component divided into two doses for mild to moderate infections, and 90 mg/kg/day divided into two doses for severe infections or in areas with high pneumococcal resistance. 1, 2
Standard Dosing Recommendations
Based on Infection Severity
- For mild to moderate infections (ear/nose/throat, skin/skin structure, genitourinary tract):
- 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
- For severe infections (ear/nose/throat, skin/skin structure, genitourinary tract):
- 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
- For lower respiratory tract infections (mild/moderate or severe):
- 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
Age-Specific Considerations
- For infants less than 12 weeks (3 months):
- Maximum recommended dose is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2
- For children 3 months and older:
- Standard dosing as outlined above based on infection severity 2
Special Formulations for Resistant Pathogens
- For persistent or recurrent acute otitis media with risk factors for resistant pathogens:
- Augmentin ES-600: 90/6.4 mg/kg/day of amoxicillin/clavulanate in two divided doses 3
- This high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, compared to the original 4:1 ratio 4
Duration of Therapy
- Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 2
- For Streptococcus pyogenes infections, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 2
- Standard treatment courses of 10 days have been best studied, although shorter courses may be effective for milder infections 5
Administration Guidelines
- Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance 2
- After reconstitution, oral suspension should be shaken well before using 2
- Any unused portion must be discarded after 14 days 2
- Refrigeration is preferable but not required 2
Monitoring and Follow-up
- Children on adequate therapy should demonstrate clinical improvement within 48-72 hours 5
- For patients whose condition deteriorates or shows no improvement within 48-72 hours, further investigation should be performed 5
Dosage Adjustments for Renal Impairment
- For children weighing more than 40 kg with severe renal impairment:
The twice-daily formulation of Augmentin has shown equivalent efficacy to the three-times-daily regimen with significantly less diarrhea (9.6% vs 26.7%), making it a more convenient and better-tolerated option for pediatric patients 6.