Injectable Amoxicillin-Clavulanate Dosing in Pediatric Patients
Standard Dosing Regimen
For pediatric patients requiring intravenous amoxicillin-clavulanate, administer 25 mg/kg of the amoxicillin component with 5 mg/kg of clavulanic acid every 6 hours (100 mg/kg/day total amoxicillin dose). 1
Age-Based Dosing Guidelines
Neonates and infants <12 weeks (<3 months):
- 30 mg/kg/day of amoxicillin component divided every 12 hours 2
- This applies to oral formulations; for IV administration, use the 25 mg/kg every 6 hours regimen 1
Infants and children ≥12 weeks (≥3 months):
- Standard infections: 25 mg/kg amoxicillin + 5 mg/kg clavulanic acid IV every 6 hours 1
- Complicated intra-abdominal infections: 200 mg/kg/day of ampicillin component IV, given every 6 hours 3
Pharmacokinetic Considerations
The IV formulation achieves mean plasma concentrations of 89.4 mcg/mL for amoxicillin and 19.5 mcg/mL for clavulanic acid at 5 minutes post-infusion when dosed at 25 mg/kg + 5 mg/kg. 1
- Terminal half-life: 1.2 hours for amoxicillin, 0.8 hours for clavulanic acid 1
- Infuse over 2 minutes for optimal plasma concentrations 1
Pathogen-Specific Coverage
This IV dosing regimen provides adequate coverage for:
- Haemophilus influenzae (including β-lactamase producing strains) 1
- Staphylococcus aureus (MSSA) 1
- Streptococci species 1
- Neisseria species 1
- Moraxella catarrhalis 1
Maximum Dosing
Do not exceed 4000 mg (4 g) per day of the amoxicillin component, regardless of weight. 3
Duration of Therapy
- Most pediatric infections: 10 days 4
- Complicated intra-abdominal infections: Duration varies by specific condition 3
- Continue therapy for 7 days after the patient becomes free of signs and symptoms 4
Clinical Monitoring
Children on appropriate antibiotic therapy should show clinical improvement within 48-72 hours. 3
- If no improvement occurs within this timeframe, reevaluation is necessary 3
- Complete the full course even if symptoms improve before completion 3
Important Clinical Pitfall
The 5:1 ratio of amoxicillin to clavulanic acid in the IV formulation differs from oral high-dose formulations (14:1 ratio), but both are pharmacokinetically compatible and clinically effective. 1, 4 The IV formulation is specifically designed for noninvasive childhood diseases requiring parenteral therapy. 1