What is the recommended liquid dose of Augmentin (amoxicillin/clavulanate) for a child?

Recommended Liquid Dose of Augmentin for Pediatric Patients

For children 3 months and older, the standard dose of Augmentin oral suspension is 45 mg/kg/day of the amoxicillin component divided every 12 hours for mild to moderate infections, or 90 mg/kg/day divided every 12 hours for severe infections or areas with high pneumococcal resistance. 1, 2, 3

Weight-Based Dosing Algorithm

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 3
• This translates to approximately 1.25 mL of 250 mg/5 mL suspension twice daily for a 5.5 kg infant 1

Severe Infections or High Resistance Areas (lower respiratory tract, severe infections):

• 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 3
• For high pneumococcal resistance: 90 mg/kg/day divided every 12 hours (maximum 4000 mg/day) 1, 2
• This translates to approximately 2.5 mL of appropriate suspension twice daily for a 5.5 kg infant 1

For Infants <3 Months (12 weeks):

• Maximum dose: 30 mg/kg/day divided every 12 hours due to immature renal function 3
• This is a critical distinction—do not exceed this dose in neonates and young infants 3

Specific Clinical Scenarios

Acute Otitis Media with Risk Factors:

• Use 90 mg/kg/day of amoxicillin component (high-dose formulation) if the child received antibiotics in the previous 30 days or has concurrent purulent conjunctivitis 2
• The 14:1 ratio formulation (Augmentin ES-600) provides 600 mg amoxicillin per 5 mL 4

Acute Bacterial Rhinosinusitis:

• 90 mg/kg/day with 6.4 mg/kg/day of clavulanate in two divided doses 2
• Duration: 10-14 days for children (longer than adults) 2

Community-Acquired Pneumonia:

• Mild to moderate: 45 mg/kg/day in 2 doses 1
• Severe or high resistance: 90 mg/kg/day in 2 doses 1
• Duration: 10 days minimum 1

Practical Dosing Examples

For a 13.6 kg child with respiratory infection:

• Standard dose: 6.1 mL of 250 mg/5 mL suspension twice daily 1

For a 5.5 kg infant (3 months old):

• Mild infection: 1.25 mL twice daily 1
• Severe infection: 2.5 mL twice daily 1

Critical Monitoring Parameters

• Assess clinical response within 48-72 hours—if no improvement, reevaluation and alternative therapy are necessary 1, 2, 3
• Continue treatment for minimum 48-72 hours beyond symptom resolution 3
• For Streptococcus pyogenes infections: minimum 10 days to prevent acute rheumatic fever 3

Common Pitfalls to Avoid

Underdosing in High-Resistance Areas:

• In communities with >10% penicillin-resistant S. pneumoniae, always use the 90 mg/kg/day high-dose regimen 2
• Recent antibiotic use (within 30 days) mandates high-dose therapy 2

Incorrect Formulation Selection:

• The standard 4:1 ratio formulation causes significantly more diarrhea (26.7%) compared to newer formulations (8.7-9.6%) 5
• Use the 7:1 or 14:1 ratio formulations when available to minimize gastrointestinal adverse effects 4, 5

Renal Impairment:

• Children with GFR <30 mL/min should NOT receive standard dosing 3
• Adjust to every 12-24 hours depending on severity of renal impairment 3

Preparation and Administration

• Reconstitute suspension at dispensing according to bottle size (see FDA label for specific volumes) 3
• Shake well before each use 3
• Administer at the start of a meal to minimize gastrointestinal intolerance 3
• Discard after 14 days; refrigeration preferred but not required 3
• Can be mixed with formula, milk, or juice if needed, but must be taken immediately 3