Maximum Oral Augmentin Dose for LRTI in a 6-Year-Old, 27 kg Patient
For a 6-year-old child weighing 27 kg with lower respiratory tract infection, the maximum oral dose of Augmentin is 90 mg/kg/day of the amoxicillin component (2430 mg/day total amoxicillin), divided into 2 doses of 1215 mg each, with an absolute maximum daily limit of 4000 mg amoxicillin per day. 1
Dosing Algorithm for This Patient
For community-acquired pneumonia or LRTI in this 27 kg child:
Standard dosing: 45 mg/kg/day of amoxicillin component = 1215 mg/day divided into 2 doses (607.5 mg twice daily) for mild to moderate infections 2, 1
High-dose regimen: 90 mg/kg/day of amoxicillin component = 2430 mg/day divided into 2 doses (1215 mg twice daily) for severe infections or areas with high pneumococcal resistance 2, 1, 3
Absolute maximum: The amoxicillin component should not exceed 4000 mg per day regardless of weight-based calculations 1
When to Use High-Dose vs Standard-Dose
Use the high-dose regimen (90 mg/kg/day) when: 1, 3
- Severe LRTI or pneumonia is present
- High local pneumococcal resistance patterns exist
- Recent antibiotic exposure within past 3 months
- Daycare attendance
- Failed initial standard-dose therapy
Use standard-dose regimen (45 mg/kg/day) when: 1, 3
- Mild to moderate infection without risk factors
- No recent antibiotic exposure
- No daycare attendance
Specific Pathogen Considerations
For β-lactamase producing H. influenzae (common LRTI pathogen):
- The Infectious Diseases Society of America recommends either 45 mg/kg/day in 3 doses OR 90 mg/kg/day in 2 doses of the amoxicillin component 2
- For this 27 kg patient: either 405 mg three times daily OR 1215 mg twice daily
Critical Dosing Details from FDA Label
The FDA-approved dosing for lower respiratory tract infections in pediatric patients is 45 mg/kg/day in divided doses every 12 hours OR 40 mg/kg/day in divided doses every 8 hours for severe infections 4
For severe LRTI specifically, FDA recommends 875 mg every 12 hours for adults, or 45 mg/kg/day divided every 12 hours for children under 40 kg 4
Treatment Duration
- Continue therapy for minimum 10 days for LRTI/pneumonia 1
- Treat for at least 48-72 hours beyond symptom resolution 1, 4
- Clinical improvement should be evident within 48-72 hours; if not, reevaluation is necessary 1
Important Caveats
Common pitfall: The clavulanate component ratio differs between formulations. The high-dose formulation (Augmentin ES-600 or 90/6.4 formulation) uses a 14:1 ratio to minimize gastrointestinal side effects while maximizing amoxicillin dosing 5, 6
Administration: Give at the start of meals to minimize gastrointestinal intolerance 4
Contraindication: Do NOT use the 875 mg tablet formulation in children under 40 kg, as it cannot be appropriately dosed 4