What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a child weighing 12kg?

Augmentin Dosing for a 12kg Child

For a 12kg child, the recommended dose of Augmentin (amoxicillin/clavulanate) is either 540mg per day (45 mg/kg/day of amoxicillin component) divided into three doses, or 1080mg per day (90 mg/kg/day) divided into two doses, depending on the severity of infection and local resistance patterns. 1, 2, 3

Standard Dosing Regimens

Mild to Moderate Infections

• 45 mg/kg/day of the amoxicillin component divided into:
  • Three doses (15 mg/kg every 8 hours): 180mg three times daily = 540mg total daily 1, 2
  • Two doses (22.5 mg/kg every 12 hours): 270mg twice daily = 540mg total daily 1, 2

Severe Infections or High Resistance Areas

• 90 mg/kg/day of the amoxicillin component divided into:
  • Two doses (45 mg/kg every 12 hours): 540mg twice daily = 1080mg total daily 1, 2, 3
  • This higher dosing is particularly important for β-lactamase producing Haemophilus influenzae and areas with high pneumococcal resistance 1, 2

Clinical Decision Algorithm

Choose 90 mg/kg/day (1080mg total daily) if:

• Community-acquired pneumonia in areas with high pneumococcal resistance 3
• β-lactamase producing organisms suspected (H. influenzae, M. catarrhalis) 1, 2
• Recurrent or persistent infections 4, 5
• Failed initial therapy with standard-dose amoxicillin 5, 6

Choose 45 mg/kg/day (540mg total daily) if:

• Mild to moderate respiratory tract infections 1, 2
• Skin/skin structure infections 7
• Genitourinary tract infections 7
• β-lactamase negative organisms confirmed 1, 2

Practical Administration

• Administer at the start of meals to minimize gastrointestinal intolerance 7
• Twice-daily dosing (every 12 hours) causes less diarrhea than three-times-daily dosing 5
• The suspension can be mixed with formula, milk, fruit juice, or water and must be taken immediately 7
• Continue treatment for minimum 48-72 hours beyond symptom resolution 3, 7
• For Streptococcus pyogenes infections, treat for at least 10 days to prevent acute rheumatic fever 7

Maximum Dose Considerations

• Maximum daily dose is 4000mg (4g) of the amoxicillin component per day 3
• For this 12kg child, even the high-dose regimen (1080mg/day) is well below the maximum 3

Common Pitfalls to Avoid

• Do not confuse total drug weight with amoxicillin component weight: Augmentin tablets/suspension contain both amoxicillin and clavulanate, but dosing is based on the amoxicillin component only 1, 2, 3
• Refrigeration is preferable but not required for reconstituted suspension; discard after 14 days 7
• Shake suspension well before each use 7
• If no clinical improvement within 48-72 hours, reevaluation is necessary 3

Formulation Selection

The high-dose formulation (90/6.4 mg/kg/day) provides a 14:1 ratio of amoxicillin to clavulanate, maintaining the same clavulanate dose while doubling amoxicillin, which improves tolerability compared to simply doubling the standard formulation 6