What is the recommended dose of co-amoxiclav (amoxicillin/clavulanic acid) suspension for a child?

Co-Amoxiclav Suspension Dosing for Children

For pediatric co-amoxiclav suspension, dose according to age: children under 1 year receive 2.5 ml/kg of 125/31 suspension three times daily, children 1-6 years receive 5 ml of 125/31 suspension three times daily, and children over 6 years receive 5 ml of 250/62 suspension three times daily. 1, 2

Age-Based Dosing Algorithm

Infants (<1 year)

• Dose: 2.5 ml/kg of 125/31 suspension three times daily 1
• This weight-based approach ensures appropriate dosing for smaller infants 2

Young Children (1-6 years)

• Dose: 5 ml of 125/31 suspension three times daily 1, 2
• This fixed dose simplifies administration for this age group 2

Older Children (>6 years, or 7-12 years)

• Dose: 5 ml of 250/62 suspension three times daily 1, 2
• The higher strength formulation (250/62) provides increased amoxicillin while maintaining appropriate clavulanate levels 2

Adolescents (12-18 years)

• Dose: 1 tablet of 250/125 three times daily 1
• Alternatively, can use adult dosing if weight >40 kg 3

Administration Guidance

• Administer at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 3
• The three-times-daily (tds) dosing schedule should be maintained for optimal efficacy 1, 2

Severe Infections Requiring IV Therapy

• For severe infections necessitating intravenous administration: 30 mg/kg three times daily IV 1, 2
• This applies to all pediatric age groups when oral therapy is inadequate 2

Critical Dosing Pitfalls to Avoid

• Never substitute two 250/125 tablets for one 500/125 tablet - they contain the same amount of clavulanate (125 mg), making them non-equivalent 3
• Do not use adult tablet formulations (250/125) in children weighing <40 kg - the amoxicillin to clavulanate ratio differs from pediatric suspensions 3
• Avoid using 250/125 tablets until the child weighs at least 40 kg due to inappropriate ratios for smaller children 3

Common Adverse Effects

• Gastrointestinal disturbances (diarrhea, nausea, vomiting) are the most common side effects 2, 4
• Diarrhea occurs more frequently with three-times-daily dosing compared to twice-daily regimens 4
• Monitor for hypersensitivity reactions, especially in patients with penicillin allergy history 2
• Rash may occur and requires clinical assessment 2

Special Populations

Renal Impairment

• Dose adjustment generally not required unless severe impairment present 3
• For severe renal dysfunction (GFR <30 mL/min), dosing frequency should be reduced 3

Hepatic Impairment

• Dose with caution and monitor hepatic function regularly 3