Augmentin Suspension Strengths and Dosing
Augmentin suspension is available in two standard concentrations: 125 mg/5 mL and 250 mg/5 mL, with weight-based dosing ranging from 20-90 mg/kg/day of the amoxicillin component depending on the infection severity and patient age. 1
Available Suspension Formulations
- Standard concentrations: Augmentin oral suspension comes in 125 mg amoxicillin/5 mL and 250 mg amoxicillin/5 mL formulations 1
- High-dose formulation: A specialized ES-600 formulation (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) exists for resistant infections, particularly acute otitis media 2
Pediatric Dosing Guidelines
Standard Infections (Children >3 months)
- Typical dosing: 20-45 mg/kg/day of amoxicillin component divided every 8-12 hours 1
- Mild to moderate infections: 25 mg/kg/day divided twice daily or 20 mg/kg/day divided three times daily 3
High-Dose Regimens for Resistant Pathogens
- Acute otitis media with suspected resistance: 90 mg/kg/day of amoxicillin component divided twice daily (maximum 2000 mg/day) 4, 2
- This high-dose regimen specifically targets penicillin-intermediate and penicillin-resistant Streptococcus pneumoniae with MICs ≤2 mg/L 2
Group A Streptococcal Carriers
- IDSA recommendation: 40 mg/kg/day of amoxicillin component divided into three doses for 10 days (maximum 2000 mg/day) 5, 6
Neonates and Young Infants (≤3 months)
- Maximum dose: 30 mg/kg/day divided every 12 hours 1
- This lower dosing reflects immature renal function and reduced drug clearance in this age group 1
Practical Dosing Calculations
- For 125 mg/5 mL suspension: Each 5 mL provides 125 mg amoxicillin 1
- For 250 mg/5 mL suspension: Each 5 mL provides 250 mg amoxicillin 1
- Sodium content: 125 mg/5 mL contains 0.11 mEq (2.51 mg) sodium per 5 mL; 250 mg/5 mL contains 0.15 mEq (3.36 mg) sodium per 5 mL 1
Treatment Duration Considerations
- Standard course: 7-10 days for most infections 5, 3
- Acute otitis media: 10 days recommended by the American Academy of Otolaryngology-Head and Neck Surgery 4
- Completing the full course is essential to prevent treatment failure and resistance development 6
Dosing Frequency: Twice Daily vs. Three Times Daily
- Twice-daily dosing (45/6.4 mg/kg/day) demonstrates equivalent efficacy to three-times-daily dosing (40/10 mg/kg/day) for acute otitis media 3
- Twice-daily regimens show trends toward better compliance (82.8% vs. 73.3%) and lower diarrhea rates (7.2% vs. 10.7%) 3
Special Population Adjustments
Renal Impairment
- Severe renal impairment (GFR <30 mL/min) requires dose reduction, as amoxicillin is primarily renally eliminated 1
- Hemodialysis removes amoxicillin from circulation 1
Clinical Pitfalls to Avoid
- Do not use standard adult dosing for children—weight-based dosing is mandatory 4
- Recent antibiotic exposure (within 4-6 weeks) necessitates high-dose amoxicillin/clavulanate to overcome resistant organisms 4
- Assess clinical response at 72 hours; consider alternative therapy (such as ceftriaxone) if no improvement occurs 4
- For penicillin allergy, avoid Augmentin entirely and consider cephalosporins (if no immediate hypersensitivity) or macrolides 5, 4