Maximum Dose of Augmentin for Pediatric Patients
The maximum recommended dose of Augmentin (amoxicillin/clavulanate) for pediatric patients is 90 mg/kg/day of the amoxicillin component, with a maximum daily dose of 4000 mg (4 g) per day for severe infections. 1
Standard Dosing Guidelines
- For mild to moderate infections, the recommended dose is 45 mg/kg/day of the amoxicillin component divided into 3 doses or 40 mg/kg/day divided into 3 doses 2
- For severe infections, including respiratory tract infections in areas with high pneumococcal resistance, the recommended dose is 90 mg/kg/day of the amoxicillin component divided into 2 doses 1, 3
- For β-lactamase producing H. influenzae infections, the recommended dose is 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses 1, 3
Age-Specific Considerations
- For infants less than 12 weeks (3 months) old: Due to incompletely developed renal function, the maximum dose is 30 mg/kg/day divided every 12 hours 2
- For children 3 months and older: Dosing is primarily weight-based rather than age-based 1
- For children weighing less than 40 kg with severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
Formulation Considerations
- The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate in an oral suspension 3
- Standard formulations typically have a 4:1 or 7:1 ratio of amoxicillin to clavulanate 4
- The high-dose formulation (90 mg/kg/day) was developed specifically to address infections caused by resistant pathogens, particularly penicillin-resistant S. pneumoniae 5
Renal Impairment Adjustments
- Patients with glomerular filtration rate (GFR) of less than 30 mL/min should NOT receive the 875 mg dose 2
- For patients with GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity 2
- For patients with GFR less than 10 mL/min: 500 mg or 250 mg every 24 hours, depending on infection severity 2
Duration of Therapy
- Treatment should be continued for a minimum of 48-72 hours beyond the time that the patient becomes asymptomatic 2
- For Streptococcus pyogenes infections, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 2
- For most respiratory infections, a 7-10 day course is typically recommended 1
Clinical Considerations
- Serum levels of amoxicillin increase linearly with the dose, and the difference in adverse effects between lower and higher doses is generally negligible 3
- The twice-daily dosing regimen (90 mg/kg/day) has shown equivalent efficacy to three-times-daily dosing with potentially better compliance 6
- Common adverse effects include diarrhea, nausea, vomiting, and rash 3
- To minimize gastrointestinal intolerance, Augmentin should be taken at the start of a meal 2
The high-dose amoxicillin/clavulanate formulation (90 mg/kg/day) is particularly valuable for treating infections where resistant pathogens are suspected, such as recurrent or persistent acute otitis media after failure of amoxicillin alone 7, 5.