What is the recommended dosage of Augmentin (amoxicillin/clavulanate) 400 mg/5 mL suspension for a patient with pneumonia?

Augmentin 400 mg/5 mL Dosing for Pediatric Pneumonia

For pneumonia in children 3 months and older, the recommended dose of Augmentin 400 mg/5 mL suspension is based on 45 mg/kg/day of the amoxicillin component divided every 12 hours for standard cases, or 90 mg/kg/day divided every 12 hours for severe infections or areas with high pneumococcal resistance. 1, 2, 3

Standard Dosing Algorithm

For Mild to Moderate Pneumonia

• Dose: 45 mg/kg/day of amoxicillin component divided every 12 hours 3
• Using 400 mg/5 mL suspension: Calculate total daily dose, then divide by 2 for twice-daily administration 2
• Example: For a 10 kg child: 450 mg/day ÷ 2 = 225 mg per dose = approximately 2.8 mL twice daily 2

For Severe Pneumonia or High Resistance Areas

• Dose: 90 mg/kg/day of amoxicillin component divided every 12 hours 1, 2, 4
• This higher dose is critical to overcome pneumococcal resistance and is the preferred regimen recommended by the Infectious Diseases Society of America 2, 4
• Example: For a 10 kg child: 900 mg/day ÷ 2 = 450 mg per dose = approximately 5.6 mL twice daily 2

Specific Clinical Scenarios

Fully Immunized Children Without Risk Factors

• Start with 45 mg/kg/day divided every 12 hours 3
• If no improvement within 48-72 hours, escalate to 90 mg/kg/day or consider hospitalization 2, 5

Not Fully Immunized or β-lactamase Producing H. influenzae Suspected

• Use 90 mg/kg/day divided every 12 hours from the outset 1, 2
• This provides adequate coverage for β-lactamase producing organisms 1, 4

Children ≥5 Years with Atypical Features

• Consider adding azithromycin (10 mg/kg day 1, then 5 mg/kg days 2-5) to the Augmentin regimen 4, 5
• Atypical pathogens like Mycoplasma pneumoniae become more common in this age group 4

Critical Dosing Considerations

Maximum Daily Dose

• Do not exceed 4000 mg (4 g) of amoxicillin component per day, regardless of weight 2, 3
• For children weighing ≥40 kg, use adult dosing recommendations 3

Treatment Duration

• 10 days of treatment is recommended for pneumonia 2, 4, 5
• This is longer than the 7-day course sometimes used for other respiratory infections 2

Administration Timing

• Give at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 3
• The every 12-hour regimen causes significantly less diarrhea than every 8-hour dosing 3

Common Pitfalls to Avoid

Underdosing Error

• Never use 40-45 mg/kg/day for pneumonia in areas with any pneumococcal resistance 2, 4
• This is the most common and dangerous dosing error, as it fails to achieve adequate concentrations against resistant Streptococcus pneumoniae 4

Formulation Confusion

• The 400 mg/5 mL suspension contains 400 mg amoxicillin and 57 mg clavulanate per 5 mL 3
• Do not substitute different strength formulations without recalculating the dose, as clavulanate content varies 3

Failure to Reassess

• All patients must be reassessed at 48-72 hours 2, 5
• Lack of improvement requires reevaluation for complications (empyema, abscess), alternative diagnoses, or resistant organisms 4, 5

When to Consider MRSA Coverage

If the child presents with:

• Necrotizing infiltrates on imaging 4
• Significant parapneumonic effusion or empyema 4
• Recent influenza infection 4
• Severe presentation requiring ICU admission 4

Add clindamycin 30-40 mg/kg/day in 3-4 doses to the Augmentin regimen, or switch to vancomycin if hospitalized 1, 4, 5