What is the appropriate dose of Augmentin (amoxicillin-clavulanate) for an 11-year-old male patient with pneumonia, weighing 36.66 kilograms?

From the Guidelines

For an 11-year-old male weighing 36.66 kg with pneumonia, the appropriate dose of Augmentin (amoxicillin-clavulanate) is 90 mg/kg/day of the amoxicillin component, divided into two doses, which translates to approximately 1649.4 mg of amoxicillin per day, or roughly 825 mg of amoxicillin twice daily, with the clavulanate component given in a fixed ratio to amoxicillin. According to the guidelines provided by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America, as outlined in the study published in Clinical Infectious Diseases 1, the recommended dosage for children over 5 years old is 90 mg/kg/day of the amoxicillin component in two doses, up to a maximum dose of 4000 mg/day.

Given the patient's weight, the calculated dose is within the recommended guidelines. The standard formulation of Augmentin for this age and weight would likely involve the 875/125 mg tablet, but to achieve the calculated dose, adjustments might be necessary, potentially involving the use of a combination of available tablet strengths or the liquid suspension formulation. It's crucial to note that Augmentin is recommended for pneumonia because it provides broad coverage against common respiratory pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, especially beta-lactamase-producing strains, thanks to the clavulanic acid component that inhibits beta-lactamase enzymes 1.

The medication should be taken with food to minimize gastrointestinal side effects, and the full course should be completed even if symptoms improve before the medication is finished. It's also important to consider local susceptibility patterns and potential allergies or intolerances to penicillins when selecting antibiotic therapy, as discussed in the guidelines 1.

Key points to consider in the management of this patient include:

• The importance of completing the full antibiotic course to ensure resolution of the infection and prevent resistance.
• Monitoring for potential side effects, especially gastrointestinal ones, which are common with antibiotic use.
• Ensuring the patient is fully immunized against common pathogens such as Haemophilus influenzae type b and Streptococcus pneumoniae, as this influences the choice of empiric antibiotic therapy.
• Being aware of local resistance patterns, which can guide the selection of appropriate antibiotic therapy, as highlighted in the study 1.

From the FDA Drug Label

Based on the amoxicillin component, amoxicillin and clavulanate potassium should be dosed as follows: Patients Aged 12 weeks (3 months) and Older: See dosing regimens provided in Table 1. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTION DOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a 125 mg/5 mL or 250 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours 40 mg/kg/day every 8 hours Less severe infections 25 mg/kg/day every 12 hours 20 mg/kg/day every 8 hours

The patient is 11 years old and weighs 36.66 kg. Since the patient weighs less than 40 kg, the dose should be based on the pediatric dosing regimen. For pneumonia, which is a lower respiratory tract infection, the recommended dose is 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours. To calculate the dose:

• 45 mg/kg/day every 12 hours: 45 mg/kg * 36.66 kg = 1649.7 mg, rounded to 1650 mg, divided by 2 (for every 12 hours) = 825 mg every 12 hours
• 40 mg/kg/day every 8 hours: 40 mg/kg * 36.66 kg = 1466.4 mg, rounded to 1466 mg, divided by 3 (for every 8 hours) = 489 mg every 8 hours The appropriate dose for Augmentin for this patient is 825 mg every 12 hours or 489 mg every 8 hours 2.

From the Research

Dosing Information for Augmentin

• The appropriate dose for Augmentin (amoxicillin/clavulanate) in an 11-year-old male weighing 36.66 kg can be determined based on the available evidence.
• According to the study 3, amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses (Augmentin ES-600) is recommended for pediatric use in persistent or recurrent acute otitis media.
• For community-acquired pneumonia, the dosing information is not explicitly stated in the provided studies for a child of this age and weight.
• However, based on the available information, the dose for pediatric patients can be calculated as 90/6.4 mg/kg/day, which would be approximately 3310/230 mg per day for a 36.66 kg child, divided into two doses.

Considerations for Treatment

• The choice of antibiotic and dosage should be guided by the severity of the pneumonia, the suspected or confirmed causative pathogen, and local resistance patterns.
• The studies 4, 5, and 6 discuss the efficacy and safety of amoxicillin/clavulanate in adults with community-acquired pneumonia, but do not provide specific dosing information for pediatric patients.
• Study 7 compares the effectiveness of different antibiotics, including amoxicillin-clavulanic acid, in treating community-acquired pneumonia, but also does not provide pediatric dosing information.