What is the maximum dose of Augmentin (amoxicillin/clavulanic acid) for a 2-year-old child?

Maximum Dose of Augmentin for a Two-Year-Old Child

The maximum dose of Augmentin (amoxicillin/clavulanate) for a 2-year-old child is 90 mg/kg/day of the amoxicillin component, divided into 2 doses, with an absolute maximum daily dose not to exceed 4000 mg of amoxicillin per day. 1

Standard Dosing Framework

For a 2-year-old child with common infections:

• High-dose formulation: 90 mg/kg/day of amoxicillin component divided into 2 doses is the recommended maximum for resistant pathogens 2, 1
• Standard-dose formulation: 45 mg/kg/day of amoxicillin component divided into 2 doses for less severe infections 2
• The high-dose regimen specifically targets β-lactamase-producing Haemophilus influenzae and penicillin-resistant Streptococcus pneumoniae 2

Indication-Specific Maximum Dosing

For community-acquired pneumonia in a 2-year-old with suspected resistant pathogens:

• Use 90 mg/kg/day of amoxicillin component in 2 divided doses 2
• This provides optimal coverage for β-lactamase-producing organisms 2

For acute otitis media (recurrent or persistent):

• The high-dose formulation (Augmentin ES-600) at 90 mg/kg/day in 2 doses is specifically designed for this indication 3, 4
• This formulation provides a 14:1 ratio of amoxicillin to clavulanate, minimizing gastrointestinal side effects while maximizing antibacterial coverage 3

Critical Dosing Considerations

Absolute maximum limits:

• Never exceed 4000 mg/day of amoxicillin, regardless of weight 2, 1
• For a typical 2-year-old weighing 12-13 kg, the maximum dose would be approximately 1080-1170 mg of amoxicillin per day (90 mg/kg/day) 1

Formulation ratios matter:

• The 7:1 ratio formulation (standard twice-daily) provides 45 mg/kg/day 3
• The 14:1 ratio formulation (ES-600) provides 90 mg/kg/day with the same clavulanate dose, reducing diarrhea risk 3, 4

Common Pitfalls to Avoid

• Do not use three-times-daily dosing for high-dose therapy—twice-daily dosing is preferred for the 90 mg/kg/day regimen and has better tolerability 1, 3
• Do not confuse total daily dose with per-dose amount—90 mg/kg/day means 45 mg/kg per dose when given twice daily 1
• Avoid using standard-dose formulations when resistant pathogens are suspected, as they provide inadequate amoxicillin concentrations 5, 4
• Do not exceed the adult maximum of 4000 mg/day total amoxicillin, even in heavier children 2, 1

Safety Profile at Maximum Dosing

• The high-dose formulation (90 mg/kg/day) shows similar tolerability to conventional formulations 4
• Gastrointestinal disturbances are the most common adverse events, but are generally mild 4
• Twice-daily dosing reduces diarrhea frequency compared to three-times-daily administration 4