What is the recommended dosage of amoxicillin-clavulanate (amoxiclav) per kilogram?

Recommended Dosage of Amoxicillin-Clavulanate (Amoxiclav) per Kilogram

For pediatric patients, the recommended dosage of amoxicillin-clavulanate is 40-90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, divided into 2-3 doses depending on the severity of infection and local resistance patterns. 1

Standard Dosing Recommendations

Pediatric Patients

• For mild to moderate infections in children without risk factors: 45 mg/kg/day of amoxicillin component in 2 divided doses 1
• For severe infections or in areas with high prevalence of resistant S. pneumoniae (>10%): 80-90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses (maximum 2g per dose) 1
• For children <12 weeks (<3 months): 30 mg/kg/day divided every 12 hours, based on amoxicillin component 2
• For children ≥12 weeks (3 months) with more severe infections: 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours 2
• For less severe infections in children ≥12 weeks: 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours 2

Risk Factors for Resistant Organisms

• Age younger than 2 years 1
• Attendance at childcare 1
• Recent antimicrobial treatment within previous 30 days 1
• Moderate to severe illness 1

Special Clinical Situations

Acute Otitis Media

• Standard dose: 40-45 mg/kg/day in 3 divided doses 3
• For resistant organisms: 75-90 mg/kg/day is recommended 3
• Every 12-hour dosing (45 mg/kg/day) is associated with significantly less diarrhea than every 8-hour dosing (40 mg/kg/day) 2

Acute Bacterial Sinusitis

• For uncomplicated cases: 45 mg/kg/day in 2 divided doses 1
• For high-risk or severe cases: 80-90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses 1

Group A Streptococcal Carriers

• 40 mg amoxicillin per kg per day in three doses (maximum = 2,000 mg amoxicillin per day) for 10 days 1

Dosing Considerations

Pharmacokinetics

• Higher doses of amoxicillin are needed to overcome resistance in S. pneumoniae 1
• Serum levels increase linearly with dose, and adverse effects are similar between lower and higher doses 1
• The 40%T>MIC pharmacodynamic target may not be reached with standard dosing in some patients 4

Formulation Considerations

• Pediatric formulations typically provide a 14:1 ratio of amoxicillin to clavulanate in oral suspension 1
• Different formulations have different amoxicillin:clavulanate ratios and are not interchangeable 2

Duration of Therapy

• Typical duration for most infections: 7-10 days 1
• For acute otitis media: 10 days is recommended 2
• For intra-abdominal infections: 4-7 days depending on severity and immune status 1

Common Pitfalls and Caveats

• Underdosing may lead to treatment failure, especially with resistant organisms 3
• The 250 mg/125 mg tablet and 250 mg/62.5 mg chewable tablet contain different amounts of clavulanate and should not be substituted for each other 2
• Patients with renal impairment (GFR <30 mL/min) should not receive the 875 mg/125 mg dose 2
• Every 12-hour dosing is associated with less diarrhea than every 8-hour dosing with similar efficacy 2
• Viral co-infection may reduce the efficacy of standard amoxicillin dosing 3

In summary, the dosage of amoxicillin-clavulanate should be tailored based on the severity of infection, local resistance patterns, and patient risk factors, with higher doses (80-90 mg/kg/day) recommended for more severe infections or in areas with high prevalence of resistant organisms.