What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 23kg child with otitis media?

Augmentin Dosage for a 23kg Child with Otitis Media

For a 23kg child with otitis media, the recommended dose of Augmentin is 80-90 mg/kg/day of the amoxicillin component, which equals approximately 1840-2070 mg/day divided into two doses (920-1035 mg twice daily). 1, 2

Dosage Calculation

• Based on the child's weight of 23kg, the appropriate dosage calculation is:

  • 80-90 mg/kg/day × 23kg = 1840-2070 mg/day of amoxicillin 1
  • Divided into 2 doses = 920-1035 mg per dose, given twice daily 1, 3

• High-dose amoxicillin-clavulanate is preferred for otitis media to overcome resistant strains of S. pneumoniae 3

• The FDA-approved formulation for children with otitis media is based on the amoxicillin component, with a 14:1 ratio of amoxicillin to clavulanate to minimize gastrointestinal side effects 2, 1

Formulation Selection

• For a 23kg child, the high-dose amoxicillin/clavulanate suspension (typically 600 mg/5 mL or 400 mg/5 mL) is recommended 1, 2

• The twice-daily regimen is preferred over three-times-daily dosing as it:

  • Shows comparable clinical efficacy 4, 5
  • Is associated with significantly less diarrhea (14% vs 34%) 2
  • Results in better medication compliance (82.8% vs 73.3%) 4

Treatment Duration

• The recommended duration of therapy for acute otitis media is 10 days 2, 3

• Children should begin to show clinical improvement within 24-48 hours of starting therapy 1

• If no improvement is seen within 48-72 hours, reassessment is necessary to confirm the diagnosis and consider changing the antibiotic 1

Special Considerations

• Amoxicillin-clavulanate is particularly indicated when:

  • The child has taken amoxicillin in the previous 30 days 3
  • The child has concurrent conjunctivitis 3
  • The child attends daycare (higher risk of resistant organisms) 3
  • The infection is moderate to severe 3, 1

• For children with vomiting or inability to tolerate oral medication, a single 50 mg/kg dose of ceftriaxone (IV or IM) can be given initially 3

Monitoring and Side Effects

• The most common adverse effect is diarrhea, occurring in approximately 7-14% of patients on the twice-daily regimen 4, 2

• The twice-daily formulation has a better gastrointestinal tolerance profile than the three-times-daily formulation 2, 4

• Pain management should be addressed regardless of antibiotic therapy 1

Clinical Efficacy

• High-dose amoxicillin-clavulanate has shown superior efficacy in eradicating S. pneumoniae (96%) from the middle ear compared to other antibiotics 3

• Clinical success rates of approximately 94% have been reported with the twice-daily regimen 4

• Amoxicillin-clavulanate is effective against the main pathogens of AOM, including penicillin-resistant S. pneumoniae, β-lactamase-producing H. influenzae, and M. catarrhalis 6, 7