Dosing Co-Amoxiclav 457mg/5mL Suspension
The appropriate dose depends on the patient's age and weight, but for most children requiring standard dosing, co-amoxiclav 457mg/5mL (which contains amoxicillin 400mg + clavulanate 57mg per 5mL) is typically given as 5mL twice daily for 7 days.
Standard Pediatric Dosing
The 457mg/5mL formulation is specifically designed for pediatric use and provides a 14:1 ratio of amoxicillin to clavulanate, which minimizes gastrointestinal side effects while maintaining efficacy 1.
Weight-Based Dosing Guidelines
For standard-dose therapy:
- Children requiring 25 mg/kg/day of amoxicillin component: Give approximately 5mL twice daily (for children weighing 16-20 kg) 1
- Children requiring higher doses: The volume should be adjusted based on the target dose of 40-45 mg/kg/day of the amoxicillin component in 2 divided doses 1
High-Dose Therapy Considerations
For infections requiring high-dose therapy (such as recurrent otitis media, persistent infections, or suspected resistant organisms):
- Target dose: 90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses 1
- For a 20 kg child: This would require approximately 11.25mL twice daily
- Maximum daily dose: 4000 mg of amoxicillin component 1
Clinical Context Matters
The specific indication determines the appropriate dosing:
For acute otitis media or sinusitis with suspected resistant pathogens: High-dose formulations (90/6.4 mg/kg/day) are preferred over standard dosing to overcome penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms 1, 2.
For uncomplicated skin/soft tissue infections or mild respiratory infections: Standard dosing of 25-45 mg/kg/day of the amoxicillin component in 2 divided doses is typically adequate 1.
Important Caveats
- Twice-daily dosing reduces diarrhea: The 457mg/5mL formulation given twice daily causes significantly less diarrhea compared to three-times-daily regimens, with comparable efficacy 3, 4
- Absorption variability: Clavulanic acid absorption can vary up to 5-fold between patients, though this doesn't typically affect clinical outcomes 5
- Take with food: Administration with meals improves gastrointestinal tolerability without compromising absorption 3
Practical Dosing Example
For a typical child weighing 20 kg with acute otitis media:
- Standard dose: 5mL twice daily for 7 days (provides 40 mg/kg/day amoxicillin)
- High dose (if treatment failure or resistant organisms suspected): 11.25mL twice daily for 7 days (provides 90 mg/kg/day amoxicillin) 1
The 7-day duration is appropriate for most respiratory tract infections in children 1, 3.