What is the recommended dose of Augmentin (amoxicillin-clavulanate) for a 25kg child?

Augmentin Dosing for a 25 kg Child

For a 25 kg child, the recommended dose of Augmentin is 45 mg/kg/day of the amoxicillin component divided into two doses (approximately 560 mg twice daily) for mild-to-moderate infections, or 90 mg/kg/day divided into two doses (approximately 1125 mg twice daily) for severe infections or in areas with high pneumococcal resistance. 1

Standard Dosing Regimens

Mild-to-Moderate Infections

• The FDA-approved dosing for pediatric patients weighing less than 40 kg is 25 mg/kg/day divided every 12 hours (or 20 mg/kg/day divided every 8 hours) for mild-to-moderate ear/nose/throat, skin/skin structure, and genitourinary tract infections 1
• For a 25 kg child with mild-to-moderate infection, this translates to 625 mg per day total, given as approximately 312 mg twice daily 1

Severe Infections or Lower Respiratory Tract Infections

• For severe infections or any lower respiratory tract infection (mild or severe), the FDA recommends 45 mg/kg/day divided every 12 hours (or 40 mg/kg/day divided every 8 hours) 1
• For a 25 kg child, this equals 1125 mg per day total, given as approximately 560 mg twice daily 1
• The Infectious Diseases Society of America supports dosing of 45 mg/kg/day in 2 doses for community-acquired pneumonia 2

High-Dose Regimen for Resistant Pathogens

• In areas with high pneumococcal resistance or for severe infections, 90 mg/kg/day of the amoxicillin component divided into 2 doses is recommended 2, 1
• For a 25 kg child, this equals 2250 mg per day total, given as approximately 1125 mg twice daily 2
• This high-dose regimen is specifically indicated for β-lactamase producing H. influenzae or drug-resistant S. pneumoniae 2

Practical Formulation Considerations

• The 250 mg/5 mL suspension is most practical for this weight range: For the standard 45 mg/kg/day regimen, administer approximately 11 mL twice daily 1
• For the high-dose 90 mg/kg/day regimen, administer approximately 22 mL twice daily 1
• Critical warning: Do NOT substitute two 250 mg tablets for one 500 mg tablet, as this results in excessive clavulanate dosing 3

Duration of Therapy

• Treatment should continue for a minimum of 48-72 hours beyond when the patient becomes asymptomatic 1
• For streptococcal infections, a minimum of 10 days of treatment is mandatory to prevent acute rheumatic fever 1
• For respiratory infections including pneumonia, 7-10 days is typical, with pneumonia specifically requiring 10 days 2

Clinical Monitoring

• Children on appropriate antibiotic therapy should show clinical improvement within 48-72 hours 2
• If no improvement occurs within this timeframe, reevaluation and consideration of alternative diagnoses or resistant pathogens is necessary 2

Important Caveats

• Administration timing: Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance 1
• The reconstituted suspension must be discarded after 14 days; refrigeration is preferable but not required 1
• Always shake the oral suspension well before each use 1