Augmentin (Amoxicillin/Clavulanate) Liquid Dosing
For pediatric patients, use 90 mg/kg/day of amoxicillin component divided into doses every 8-12 hours for most bacterial infections, with treatment duration of 5-10 days depending on the specific infection. 1, 2
Pediatric Dosing by Age and Weight
Children Under 3 Months
- Maximum dose: 30 mg/kg/day divided every 12 hours due to immature renal function 2
- Continue treatment minimum 48-72 hours beyond symptom resolution 2
Children 3 Months to Under 1 Year
- 2.5 mL/kg of 125/31 mg suspension three times daily 3
Children 1-6 Years
- 5 mL of 125/31 mg suspension three times daily 3
Children Over 6 Years (Weight <40 kg)
- 5 mL of 250/62 mg suspension three times daily 3
Infection-Specific Dosing for Children ≥3 Months and <40 kg
Mild to Moderate Infections (Ear/Nose/Throat, Skin, Genitourinary)
- 25 mg/kg/day divided every 12 hours OR
- 20 mg/kg/day divided every 8 hours 2
Severe Infections or Lower Respiratory Tract
- 45 mg/kg/day divided every 12 hours OR
- 40 mg/kg/day divided every 8 hours 2
High-Dose Regimen for Resistant Pathogens
- 90 mg/kg/day (maximum 4000 mg amoxicillin) divided twice daily for acute bacterial rhinosinusitis with recent antibiotic use or moderate disease 1
- This high-dose formulation is specifically recommended when penicillin-resistant Streptococcus pneumoniae or beta-lactamase-producing organisms are suspected 1, 4
Treatment Duration by Indication
Acute Otitis Media and Sinusitis
- 5-7 days for uncomplicated cases 1
- 10 days for children with recent antibiotic exposure or moderate disease 1
Streptococcal Pharyngitis (Chronic Carriers)
Pneumonia
- 5-7 days for mild to moderate community-acquired pneumonia 1
Intra-Abdominal Infections
- 4 days if adequate source control achieved in immunocompetent patients 1
- Up to 7 days for immunocompromised or critically ill patients 1
Administration Guidelines
Preparation and Storage
- Shake bottle vigorously until all powder flows freely before reconstitution 2
- Add water in two steps: 1/3 initially, shake, then add remainder 2
- Shake well before each use 2
- Refrigeration preferred but not required; discard after 14 days 2
Administration Technique
- Give at the start of meals to minimize gastrointestinal intolerance 2
- Place suspension directly on child's tongue OR mix with formula, milk, fruit juice, water, or cold drinks 2
- Administer mixed preparations immediately 2
Renal Impairment Adjustments (Children >40 kg)
GFR 10-30 mL/min
- 500 mg or 250 mg every 12 hours depending on severity 2
GFR <10 mL/min
- 500 mg or 250 mg every 24 hours 2
Hemodialysis
- Additional dose during and at end of dialysis 2
Important Clinical Considerations
The 875 mg tablet formulation should NOT be used in patients with GFR <30 mL/min 2. For liquid formulations in severe renal impairment, adjust frequency rather than individual dose volume.
Continue treatment minimum 48-72 hours beyond clinical improvement for all infections 2. For Streptococcus pyogenes infections, mandatory 10-day course to prevent acute rheumatic fever 2.
The high-dose amoxicillin/clavulanate regimen (90/6.4 mg/kg/day) demonstrates superior efficacy against drug-resistant S. pneumoniae and beta-lactamase-producing organisms compared to standard dosing 4. This formulation maintains the favorable safety profile of conventional doses 4.
Common pitfall: Using standard-dose amoxicillin/clavulanate in areas with high penicillin-resistant S. pneumoniae prevalence or in patients with recent antibiotic exposure leads to treatment failure 1. Always escalate to high-dose regimen (90 mg/kg/day) in these scenarios.