Augmentin Dosing for an 11-Year-Old Child
For an 11-year-old child, the appropriate Augmentin dosage depends on the infection type and severity, but typically ranges from 45 mg/kg/day divided every 12 hours for mild-moderate infections to 90 mg/kg/day divided every 12 hours for severe infections or areas with high antibiotic resistance, with a maximum of 2000 mg per dose. 1, 2
Standard Dosing Framework
Weight-Based Calculation (Most Accurate)
The typical 11-year-old weighs approximately 35-40 kg, though individual weight should always be verified. 1
For mild to moderate infections:
- 45 mg/kg/day of amoxicillin component divided every 12 hours 1, 2
- For a 35 kg child: approximately 787.5 mg twice daily
- For a 40 kg child: approximately 900 mg twice daily 3
For severe infections or high-resistance areas:
- 90 mg/kg/day of amoxicillin component divided every 12 hours 1, 2
- For a 35 kg child: approximately 1575 mg twice daily
- For a 40 kg child: approximately 1800 mg twice daily 2
- Maximum single dose: 2000 mg regardless of weight 2
Age-Based Dosing (When Weight Unknown)
For children aged 7-12 years, the standard recommendation is 5 mL of 250/62 suspension three times daily 2, though this provides lower total daily dosing than weight-based calculations and may be inadequate for resistant organisms.
Infection-Specific Recommendations
Respiratory Tract Infections
- Community-acquired pneumonia: 90 mg/kg/day in 2 doses for 10 days 1, 2
- Acute bacterial sinusitis: High-dose amoxicillin-clavulanate (90 mg/kg/day with 6.4 mg/kg/day clavulanate) if worsening after 72 hours on standard therapy 4
- Mild respiratory infections: 45 mg/kg/day in 2 doses for 7-10 days 1
Skin and Soft Tissue Infections
- Standard dosing: 45 mg/kg/day divided every 12 hours 3
- Severe infections: 90 mg/kg/day divided every 12 hours 5
- Duration: 7-10 days, extendable to 14 days based on clinical response 5
High-Dose Formulation Rationale
The high-dose regimen (90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate in a 14:1 ratio) is specifically indicated for: 2, 6
- Age <2 years
- Daycare attendance
- Recent antibiotic use within past 30 days
- Moderate to severe illness
- Geographic areas with >10% penicillin-resistant S. pneumoniae 2
This formulation maintains plasma concentrations adequate to overcome intermediately resistant S. pneumoniae (MIC up to 4 mcg/mL) while causing less diarrhea than older formulations due to the optimized ratio. 2, 7
Critical Dosing Considerations
Renal Impairment
- GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 3
- GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3
- Hemodialysis: Additional dose during and after dialysis 3
Administration Guidelines
- Take at the start of meals to minimize gastrointestinal intolerance 3
- Shake oral suspension well before each use 3
- Reconstituted suspension expires after 14 days; refrigeration preferred but not required 3
Treatment Duration
Minimum treatment duration: 48-72 hours beyond symptom resolution or bacterial eradication 3
Infection-specific durations:
- Pneumonia: 10 days 1, 2
- Sinusitis: 10-14 days 4
- Skin infections: 7-10 days (up to 14 days for severe cases) 5
- Streptococcus pyogenes infections: Minimum 10 days to prevent rheumatic fever 3
Common Pitfalls to Avoid
Underdosing is the most critical error - using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms and promotes antimicrobial resistance. 2
Verify suspension concentration (125/31 vs 250/62) before calculating volume to avoid dosing errors. 2
Do not use 875 mg tablets in patients with GFR <30 mL/min - this formulation is contraindicated in severe renal impairment. 3
Ensure appropriate indication - most upper respiratory infections are viral and do not benefit from antibiotics; confirm bacterial infection criteria before prescribing. 2
Monitoring and Follow-Up
Children should demonstrate clinical improvement within 48-72 hours of appropriate antibiotic therapy. 1, 2
If no improvement occurs:
- Reassess diagnosis
- Consider resistant organisms
- Evaluate for complications
- Consider alternative therapy (clindamycin plus cefixime, linezolid plus cefixime, or levofloxacin) 4
Complete the full prescribed course even if symptoms improve before completion to prevent treatment failure and resistance development. 2