Augmentin Liquid Formulation for Pneumonia
For treating pneumonia in children, use the high-dose amoxicillin-clavulanate formulation providing 90 mg/kg/day of the amoxicillin component divided into 2 doses, which corresponds to the 600 mg/5 mL suspension (14:1 ratio). 1, 2, 3
Specific Formulation Recommendations
The preferred liquid formulation is Augmentin ES-600 (600 mg amoxicillin/42.9 mg clavulanate per 5 mL), dosed at 90 mg/kg/day of amoxicillin in 2 divided doses. 2, 3, 4
Why This Formulation
This high-dose 14:1 ratio formulation provides adequate coverage against β-lactamase-producing Haemophilus influenzae and penicillin-resistant Streptococcus pneumoniae (the two most common bacterial pneumonia pathogens in children). 1, 3, 5
The 90 mg/kg/day dosing achieves middle ear and lung tissue concentrations that exceed the minimum inhibitory concentration for intermediately resistant and many highly resistant pneumococcal serotypes. 3, 6
The twice-daily dosing (versus three-times-daily with standard formulations) significantly reduces the incidence of diarrhea while maintaining equivalent or superior efficacy. 3, 4, 5
Alternative Standard-Dose Formulation
If the high-dose formulation is unavailable or not indicated, use the standard 400 mg/5 mL or 200 mg/5 mL suspension at 45 mg/kg/day divided every 12 hours. 1, 4
When Standard Dosing May Be Appropriate
For children without risk factors for resistant organisms (age >2 years, no recent antibiotic exposure, complete H. influenzae type b vaccination, no daycare attendance). 3, 7
In geographic areas with low pneumococcal resistance rates (<10% penicillin-resistant S. pneumoniae). 1, 3
Critical Dosing Details
Maximum daily dose is 4000 mg of amoxicillin component regardless of weight. 2, 3, 4
Formulation-Specific Considerations
The 125 mg/31.25 mg per 5 mL suspension provides a 4:1 ratio and should NOT be used for pneumonia requiring high-dose therapy, as it delivers excessive clavulanate when dosed to achieve 90 mg/kg/day of amoxicillin. 3, 4
The 250 mg/62.5 mg per 5 mL suspension provides a 4:1 ratio and is similarly inappropriate for high-dose regimens. 4
Only the 600 mg/42.9 mg per 5 mL (ES-600) formulation provides the optimal 14:1 ratio for high-dose therapy. 3, 4, 8
Treatment Duration and Monitoring
Continue treatment for 10 days for bacterial pneumonia. 1, 3
Expected Clinical Response
Children should demonstrate clinical improvement within 48-72 hours of initiating appropriate therapy. 1, 2, 7
If no improvement or clinical deterioration occurs after 48-72 hours, reevaluate for complications, atypical pathogens, or alternative diagnoses. 1, 3, 7
Common Pitfalls to Avoid
Do not substitute two 250 mg/125 mg tablets or equivalent suspension volume for one 500 mg/125 mg dose, as the clavulanate content differs and this creates inappropriate ratios. 4
Verify the suspension concentration before calculating volume—prescribing errors commonly occur when providers confuse the 125/31,250/62,400/57, and 600/42.9 formulations. 3, 4
Do not use the 875 mg/125 mg tablet formulation in children, as it cannot be appropriately dosed by weight and provides excessive clavulanate. 4
Ensure administration at the start of meals to enhance clavulanate absorption and minimize gastrointestinal adverse effects. 4