What is the recommended dosage of Augmentin (amoxicillin/clavulanate) for a 2-year-old child weighing 27 pounds?

Augmentin Dosing for a 2-Year-Old Weighing 27 Pounds

For a 2-year-old child weighing 27 pounds (12.3 kg), prescribe Augmentin 45 mg/kg/day of the amoxicillin component divided into two doses (approximately 275 mg twice daily) for standard respiratory infections, or 90 mg/kg/day divided into two doses (approximately 550 mg twice daily) for severe infections or areas with high pneumococcal resistance. 1, 2

Weight-Based Calculation

• Convert weight: 27 pounds = 12.3 kg 2
• Standard dosing (45 mg/kg/day): 12.3 kg × 45 mg/kg = 553.5 mg/day total, divided into 2 doses = approximately 275 mg per dose twice daily 1, 2
• High-dose regimen (90 mg/kg/day): 12.3 kg × 90 mg/kg = 1,107 mg/day total, divided into 2 doses = approximately 550 mg per dose twice daily 1, 2

Specific Formulation and Volume

Using the 200 mg/5 mL suspension (most appropriate for this age): 2

• Standard dose: 275 mg = approximately 6.9 mL twice daily 2
• High dose: 550 mg = approximately 13.8 mL twice daily 2

Using the 400 mg/5 mL suspension (alternative): 2

• Standard dose: 275 mg = approximately 3.4 mL twice daily 2
• High dose: 550 mg = approximately 6.9 mL twice daily 2

Indication-Specific Recommendations

For mild to moderate respiratory infections (community-acquired pneumonia, sinusitis, otitis media): 3, 1

• Use 45 mg/kg/day divided twice daily (approximately 275 mg or 6.9 mL of 200 mg/5 mL suspension twice daily) 1, 2

For severe infections or high pneumococcal resistance areas: 3, 1

• Use 90 mg/kg/day divided twice daily (approximately 550 mg or 13.8 mL of 200 mg/5 mL suspension twice daily) 1, 2
• This higher dose is particularly important if the child has received antibiotics within the past 3 months 1

For β-lactamase producing H. influenzae: 3, 1

• Either 45 mg/kg/day in 3 doses OR 90 mg/kg/day in 2 doses of the amoxicillin component 3

Sample Prescription Format

Standard dose prescription:

• Augmentin 200 mg/5 mL oral suspension
• Dose: 7 mL (rounded from 6.9 mL for practical measurement) by mouth twice daily
• Duration: 10 days for pneumonia/AOM; 7-10 days for other respiratory infections 1, 2
• Dispense: 140 mL bottle 2

High dose prescription:

• Augmentin 400 mg/5 mL oral suspension
• Dose: 7 mL (rounded from 6.9 mL for practical measurement) by mouth twice daily
• Duration: 10 days 1, 2
• Dispense: 140 mL bottle 2

Critical Considerations

The twice-daily regimen is strongly preferred over three-times-daily dosing because it significantly reduces the incidence of diarrhea and improves compliance 2, 4

Treatment duration: 1

• Acute otitis media: 10 days 2
• Community-acquired pneumonia: 10 days 1
• Other respiratory infections: 7-10 days 1

Expected clinical improvement should occur within 48-72 hours; if no improvement is seen, reevaluation is necessary to consider resistant pathogens or alternative diagnoses 1, 5

Common Pitfalls to Avoid

Do not substitute formulations incorrectly: The 250 mg/125 mg tablet and 250 mg/62.5 mg chewable tablet are NOT interchangeable due to different clavulanate content 2

Do not use adult tablets (250 mg/125 mg or 500 mg/125 mg) until the child weighs at least 40 kg due to incorrect amoxicillin-to-clavulanate ratios 2

Administer with food to improve gastrointestinal tolerability, though this is not required for absorption 2