Maximum Daily Augmentin Dose for 8-Year-Old with Strep Pharyngitis
For an 8-year-old child with streptococcal pharyngitis, Augmentin is NOT the first-line treatment—amoxicillin alone should be used at 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days. 1
Why Augmentin is Not First-Line
The Infectious Diseases Society of America guidelines clearly recommend amoxicillin alone (without clavulanate) as first-line therapy for uncomplicated Group A streptococcal pharyngitis in children, with a "Strong, high" evidence rating 1
Augmentin (amoxicillin/clavulanate) is reserved for recurrent or treatment-failure cases, not initial treatment of strep pharyngitis 1, 2
If Augmentin Must Be Used (Recurrent Cases)
The maximum daily dose of Augmentin for recurrent strep pharyngitis in children is 40 mg/kg/day of the amoxicillin component, divided into 3 equal doses for 10 days (maximum 750 mg of amoxicillin per day). 1, 2
Dosing Calculation for an 8-Year-Old:
- Assuming average weight of ~25 kg for an 8-year-old: 40 mg/kg/day = 1000 mg/day of amoxicillin component
- However, the guideline-specified maximum is 750 mg/day of amoxicillin when using Augmentin for this indication 1
- This would be divided into 3 doses: approximately 250 mg of amoxicillin component three times daily 1
Critical Dosing Warnings
Two 250 mg tablets of Augmentin are NOT equivalent to one 500 mg tablet because both contain 125 mg of clavulanate, which would result in excessive clavulanate exposure 2
The FDA label indicates that for severe infections in children, the dose can go up to 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours, but this is for general infections, not specifically strep pharyngitis 3
Essential Treatment Principles
Complete the full 10-day course regardless of symptom improvement to prevent acute rheumatic fever 1, 2
Patients become non-contagious after 24 hours of appropriate antibiotic therapy 4, 2
For standard, uncomplicated strep pharyngitis, switch to amoxicillin alone at the higher doses mentioned above (50 mg/kg once daily, max 1000 mg) for superior efficacy and lower side effect profile 1, 5
Common Pitfall to Avoid
The most common error is using Augmentin as first-line therapy when amoxicillin alone is more appropriate, equally effective, better tolerated (less diarrhea), and specifically recommended by guidelines for uncomplicated strep pharyngitis 1, 6