What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 2-year-old child with pneumonia?

Augmentin Dosing for a 2-Year-Old with Pneumonia

For a 2-year-old child with community-acquired pneumonia, prescribe Augmentin at 90 mg/kg/day of the amoxicillin component, divided into 2 doses (given every 12 hours), for 10 days. 1

Weight-Based Calculation

• First, obtain the child's weight in kilograms to calculate the precise dose 1
• Multiply the weight (kg) by 90 mg to get the total daily amoxicillin dose 1
• Divide this total by 2 to determine the dose for each administration (twice daily) 1

Example: For a typical 2-year-old weighing 12 kg:

• Total daily dose: 12 kg × 90 mg/kg = 1,080 mg/day
• Per-dose amount: 1,080 mg ÷ 2 = 540 mg twice daily 1

Rationale for High-Dose Regimen

The 90 mg/kg/day dosing is specifically designed to overcome penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing Haemophilus influenzae, the most common bacterial causes of pediatric pneumonia. 1, 2, 3

• This high-dose regimen provides superior pharmacokinetic profiles compared to lower doses 2
• The twice-daily dosing (rather than three-times-daily) improves adherence while maintaining efficacy 2, 4
• The maximum absolute daily dose should not exceed 4,000 mg (4 g) of amoxicillin, regardless of weight 1, 3

Treatment Duration

Pneumonia requires a full 10-day course of Augmentin treatment. 1

• This duration is specifically recommended for community-acquired pneumonia in children under 5 years 1
• Complete the entire course even if symptoms improve earlier 1

When to Use Standard vs. High-Dose

Use the 90 mg/kg/day high-dose regimen if any of the following apply:

• Severe pneumonia presentation 1
• Geographic area with high pneumococcal resistance 1, 3
• Recent antibiotic exposure within the past 3 months 1
• Inadequate H. influenzae type b vaccination 1
• Concurrent purulent acute otitis media 1

The lower dose of 45 mg/kg/day in 2 doses may be considered only for mild pneumonia in areas with low resistance, but this is rarely appropriate given current resistance patterns. 1

Monitoring and Follow-Up

The child should demonstrate clinical improvement within 48-72 hours of starting therapy. 1

• If no improvement occurs within this timeframe, reevaluation and further investigation are mandatory 1
• Consider treatment failure if fever persists beyond 72 hours or respiratory symptoms worsen 1

Formulation Selection

Use the high-dose Augmentin ES-600 formulation (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) when available, as it provides the 14:1 ratio of amoxicillin to clavulanate. 4

• This formulation minimizes clavulanate-related diarrhea while maximizing amoxicillin exposure 4
• The 14:1 ratio is superior to older 4:1 or 7:1 formulations for reducing gastrointestinal side effects 4

Common Pitfalls to Avoid

• Do not use age-based dosing—always calculate based on actual weight 1
• Do not prescribe the standard-dose formulation (45 mg/kg/day) for pneumonia—this is inadequate for resistant pathogens 1, 3
• Do not stop treatment early even if the child appears well—pneumonia requires the full 10-day course 1
• Do not exceed 4,000 mg/day of the amoxicillin component regardless of calculated weight-based dose 1, 3

Adverse Effects

The most common adverse effects are gastrointestinal disturbances, including diarrhea, nausea, and vomiting. 1 Twice-daily dosing reduces diarrhea frequency compared to three-times-daily administration. 5, 4