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

Augmentin Dosing for Pediatric Patients

For most pediatric respiratory tract infections, the recommended dose of Augmentin (amoxicillin/clavulanate) is 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, divided into two doses daily, with a maximum of 4000 mg/day. 1

Standard High-Dose Regimen

• The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate (90/6.4 mg/kg/day in 2 divided doses), which is the preferred regimen for most pediatric infections. 1
• This dosing achieves adequate middle ear fluid concentrations to overcome penicillin-resistant Streptococcus pneumoniae and covers β-lactamase-producing organisms like Haemophilus influenzae and Moraxella catarrhalis. 1
• The maximum single dose is 2000 mg of amoxicillin regardless of weight. 1

Age-Based Dosing Considerations

For infants under 3 months:

• The maximum dose is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function. 2
• Treatment should continue for at least 48-72 hours beyond symptom resolution. 2

For children 3 months and older:

• Mild to moderate infections: 45 mg/kg/day in 2-3 divided doses 2
• Severe infections or high-resistance areas: 90 mg/kg/day in 2 divided doses 1

Indication-Specific Dosing

Community-acquired pneumonia:

• Children under 5 years: 90 mg/kg/day of amoxicillin component in 2 doses 1
• Treatment duration: 10 days 3, 1

Acute bacterial rhinosinusitis:

• High-dose regimen (90/6.4 mg/kg/day) for children with recent antibiotic use (within 4-6 weeks) or moderate disease 3
• Standard dose (45 mg/kg/day) acceptable for mild disease without recent antibiotic exposure 3

β-lactamase producing H. influenzae:

• Either 45 mg/kg/day in 3 doses OR 90 mg/kg/day in 2 doses 1

When to Use High-Dose Regimen

High-dose therapy (90/6.4 mg/kg/day) is indicated for children with ANY of these risk factors: 1

• Age less than 2 years
• Daycare attendance
• Recent antibiotic use (within past 3 months)
• Incomplete Haemophilus influenzae type b vaccination (less than 3 injections)
• Geographic area with high pneumococcal resistance (>10%)
• Moderate to severe illness
• Concurrent purulent acute otitis media

Treatment Duration and Monitoring

• Standard duration: 10 days for most respiratory infections 3, 1
• Children should demonstrate clinical improvement within 48-72 hours of starting therapy. 3, 1
• If no improvement or worsening occurs after 72 hours, reevaluate and consider switching antibiotics or further investigation for complications. 1

Critical Dosing Pitfalls to Avoid

Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms. 1

• Subtherapeutic doses fail to achieve adequate serum and tissue concentrations and promote antimicrobial resistance. 1
• Always verify the suspension concentration (125/31 vs 250/62 mg/5mL) before calculating volume to avoid dosing errors. 1

The 14:1 ratio formulation (90/6.4 mg/kg/day) causes significantly less diarrhea than older formulations while maintaining efficacy. 1, 4

• Diarrhea incidence: 8.7-9.6% with twice-daily high-dose formulation versus 26.7% with three-times-daily standard formulation 4

Renal Impairment Adjustments

For children over 3 months and weighing >40 kg with severe renal impairment: 2

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours
• Hemodialysis: Additional dose during and at end of dialysis 2

Administration Guidance

• Administer at the start of meals to minimize gastrointestinal intolerance. 2
• Shake oral suspension well before each use. 2
• Refrigeration is preferable but not required; discard unused suspension after 14 days. 2