What is the Augmentin (amoxicillin/clavulanate) dose for a child weighing 91 pounds?

Augmentin Dosing for a 91-Pound Child

For a child weighing 91 pounds (41.3 kg), the standard Augmentin dose is 45 mg/kg/day of the amoxicillin component divided into two doses (approximately 930 mg twice daily), or 90 mg/kg/day (approximately 1860 mg twice daily) for severe infections or areas with high pneumococcal resistance. 1, 2

Weight-Based Dosing Calculation

• A 91-pound child weighs approximately 41.3 kg 3
• Since this child weighs more than 40 kg, adult dosing recommendations should be followed 3
• For standard infections: 500 mg/125 mg tablet every 12 hours or 250 mg/125 mg tablet every 8 hours 3
• For more severe respiratory tract infections: 875 mg/125 mg tablet every 12 hours or 500 mg/125 mg tablet every 8 hours 3

Severity-Based Dosing Strategy

For mild to moderate infections:

• The standard dose is 45 mg/kg/day divided every 12 hours, which equals approximately 930 mg twice daily for this 41.3 kg child 1, 2
• This translates to the 500 mg/125 mg tablet twice daily in practical terms 3

For severe infections or high-resistance areas:

• High-dose therapy of 90 mg/kg/day divided every 12 hours is recommended, equaling approximately 1860 mg twice daily 1, 2
• This translates to the 875 mg/125 mg tablet twice daily 3
• The American Academy of Pediatrics recommends a maximum of 4000 mg per day of the amoxicillin component for severe infections 1

Indication-Specific Recommendations

For otitis media, sinusitis, or lower respiratory tract infections:

• Use 45 mg/kg/day every 12 hours (approximately 500 mg twice daily) for standard cases 3
• The FDA label specifically recommends this dosing for these indications in children over 40 kg 3

For community-acquired pneumonia:

• The Infectious Diseases Society of America recommends 90 mg/kg/day of the amoxicillin component in 2 doses for areas with pneumococcal resistance 1
• This translates to 875 mg twice daily for this child 3

Duration of Therapy

• For most respiratory tract infections, 7-10 days of therapy is recommended 2, 4
• For acute otitis media specifically, 10 days is the studied and recommended duration 3
• Clinical improvement should be evident within 48-72 hours; if not, reevaluation is necessary 2

Important Formulation Considerations

• Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amounts of clavulanic acid 3
• The 250 mg/125 mg tablet contains 125 mg of clavulanic acid, while the 250 mg/62.5 mg chewable tablet contains only 62.5 mg 3
• Augmentin should be taken at the start of a meal to enhance absorption of clavulanate and minimize gastrointestinal side effects 3

Common Pitfalls to Avoid

• Avoid underdosing in areas with high pneumococcal resistance - consider the 875 mg twice daily regimen rather than 500 mg 1, 2
• Do not use pediatric weight-based calculations (mg/kg) once a child reaches 40 kg; switch to adult dosing 3
• Ensure completion of the full course even if symptoms improve before completion 2
• The most common adverse effects include gastrointestinal disturbances such as diarrhea, nausea, and vomiting 1