Co-Amoxiclav Dosing for 5-Year-Old with URTI
For a 5-year-old child with an upper respiratory tract infection (URTI), co-amoxiclav 457mg/5ml should NOT be used as first-line therapy; plain amoxicillin is the preferred initial treatment unless there are specific indications for broader coverage. 1
First-Line Treatment Recommendation
Amoxicillin alone at 45 mg/kg/day divided into 2 doses is the recommended first-line therapy for children under 5 years with respiratory tract infections, as it effectively covers the most common pathogens (Streptococcus pneumoniae, non-β-lactamase producing Haemophilus influenzae) and is well-tolerated and cost-effective. 1
For more severe infections or areas with high pneumococcal resistance, increase to 90 mg/kg/day divided into 2 doses. 1, 2
When Co-Amoxiclav IS Indicated
Co-amoxiclav (amoxicillin/clavulanate) becomes appropriate in specific scenarios:
- Inadequate H. influenzae type b vaccination status 2
- Concurrent purulent acute otitis media 2
- Suspected β-lactamase producing organisms (particularly H. influenzae or Moraxella catarrhalis) 1
- Failed initial amoxicillin therapy after 48-72 hours 1, 2
Correct Dosing IF Co-Amoxiclav Is Used
If co-amoxiclav is clinically indicated, the dosing should be based on the amoxicillin component:
- Standard dose: 45 mg/kg/day of amoxicillin component divided into 2 doses (every 12 hours) 1, 2
- High dose: 90 mg/kg/day of amoxicillin component divided into 2 doses for severe infections or resistant organisms 1, 2
Practical Calculation for 457mg/5ml Suspension
The 457mg/5ml formulation contains approximately 400mg amoxicillin + 57mg clavulanate per 5ml (7:1 ratio). 3, 4
For a typical 5-year-old weighing approximately 18-20 kg:
- Standard dose (45 mg/kg/day): 810-900 mg/day total = 5ml twice daily (approximately 400mg per dose)
- High dose (90 mg/kg/day): 1620-1800 mg/day total = 10ml twice daily (approximately 800mg per dose)
Treatment Duration and Monitoring
- Continue therapy for 7-10 days for most respiratory infections. 2, 5
- Reassess at 48-72 hours if no clinical improvement is observed; further investigation or treatment modification may be necessary. 1, 2
- Complete the full course even if symptoms improve before completion. 2
Critical Pitfalls to Avoid
- Do not use co-amoxiclav as routine first-line therapy for simple URTIs in fully immunized children, as this promotes unnecessary resistance and increases side effects (particularly diarrhea). 1, 6
- Ensure dosing is based on the amoxicillin component, not the total combination weight. 1, 2
- Shake suspension well before each use and refrigerate after reconstitution (though not required); discard after 14 days. 5
- Most URTIs are viral and may not require antibiotics at all; young children with mild lower respiratory symptoms need not be treated with antibiotics. 1