What is the appropriate dose of Augmentin (amoxicillin-clavulanate) for acute otitis media (AOM) in a 29-pound child?

From the Guidelines

For a 29 lb (approximately 13.2 kg) baby with acute otitis media (AOM), the recommended dose of Augmentin (amoxicillin-clavulanate) is 90 mg/kg/day of the amoxicillin component, divided into two doses, as recommended by the most recent and highest quality study 1. This translates to approximately 600 mg of amoxicillin per day, or 300 mg twice daily.

Key Considerations

• The most appropriate formulation would be Augmentin ES (600 mg/5 mL), giving 2.5 mL twice daily for 10 days, as it provides the required high-dose amoxicillin component to overcome resistant Streptococcus pneumoniae.
• Alternatively, standard Augmentin suspension (400 mg/5 mL) could be used at a dose of 3.75 mL twice daily.
• Augmentin is preferred for AOM when there is concern for beta-lactamase producing organisms or if the child has received antibiotics in the past 30 days, as stated in the guidelines 1.
• The high-dose amoxicillin component helps overcome resistant Streptococcus pneumoniae, while the clavulanate addresses beta-lactamase producing Haemophilus influenzae and Moraxella catarrhalis.

Administration and Duration

• The medication should be given with food to minimize gastrointestinal side effects.
• Parents should complete the full course even if symptoms improve before completion, to ensure optimal treatment outcomes and prevent the development of antibiotic resistance.

Rationale

• The recommended dose is based on the latest guidelines from the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) 1, which emphasize the importance of high-dose amoxicillin in the treatment of AOM.
• The use of Augmentin is supported by its effectiveness against common AOM bacterial pathogens, as well as its safety, low cost, acceptable taste, and narrow microbiologic spectrum 1.

From the FDA Drug Label

Table 1 ... Ear/Nose/Throat Mild/ Moderate 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours Severe 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours

The appropriate dose of Augmentin (amoxicillin-clavulanate) for acute otitis media (AOM) in a 29-pound child is:

• For mild/moderate infections: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
• For severe infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours To calculate the dose, first convert the child's weight from pounds to kilograms: 29 pounds is approximately 13.2 kilograms.
• For mild/moderate infections: 25 mg/kg/day is approximately 330 mg per day, which can be divided into 2-3 doses
• For severe infections: 45 mg/kg/day is approximately 594 mg per day, which can be divided into 2-3 doses 2

From the Research

Dosing Recommendations for Augmentin in Acute Otitis Media

The appropriate dose of Augmentin (amoxicillin-clavulanate) for acute otitis media (AOM) in a 29-pound child can be determined based on the child's weight.

• A dose of 40-45 mg/kg/day is considered a standard dose, while a high dose is 80-90 mg/kg/day 3, 4.
• For a 29-pound (approximately 13.2 kg) child, the standard dose would be around 530-595 mg per day, and the high dose would be around 1060-1188 mg per day.
• However, it's essential to consider the specific formulation of Augmentin, as different formulations may have different dosing recommendations.

Considerations for High-Dose Amoxicillin

• High-dose amoxicillin (80-90 mg/kg/day) is recommended for the treatment of AOM, especially in areas with a high prevalence of drug-resistant Streptococcus pneumoniae 5, 6, 4.
• The high-dose formulation of amoxicillin-clavulanate (90/6.4 mg/kg/day) has been shown to be effective in eradicating penicillin-resistant S. pneumoniae 3.
• However, one study found that high-dose amoxicillin did not have a significant benefit over standard-dose amoxicillin in children at low risk for infection with antibiotic-resistant bacteria 7.

Important Notes

• The dosing recommendations may vary depending on the specific formulation of Augmentin and the child's individual needs.
• It's crucial to consult with a healthcare professional to determine the most appropriate dose and treatment plan for the child.