What is the recommended dose of amoxicillin (Augmentin) for a 10 kg child?

Amoxicillin-Clavulanate Dosing for a 10 kg Child

For a 10 kg child, the recommended dose of amoxicillin-clavulanate (Augmentin) is 450 mg of the amoxicillin component twice daily (90 mg/kg/day) for most respiratory tract infections, or 225 mg twice daily (45 mg/kg/day) for mild infections in low-risk children. 1, 2

Standard Dosing Framework

The choice between standard-dose and high-dose regimens depends on specific risk factors and infection severity:

High-Dose Regimen (90 mg/kg/day of amoxicillin component)

Use high-dose amoxicillin-clavulanate (90 mg/kg/day with 6.4 mg/kg/day clavulanate in 2 divided doses) for children with any of the following risk factors: 1, 3

• Age younger than 2 years 1
• Daycare attendance 1
• Recent antibiotic use within the past 30 days 1
• Moderate to severe illness 1
• Geographic areas with high pneumococcal resistance (>10%) 1, 2
• Incomplete Haemophilus influenzae type b vaccination (fewer than 3 doses) 3
• Concurrent purulent acute otitis media 2

For a 10 kg child, this translates to 450 mg of amoxicillin component twice daily (total 900 mg/day), with a maximum single dose of 2 grams regardless of weight. 2, 3

Standard-Dose Regimen (45 mg/kg/day of amoxicillin component)

Use standard-dose amoxicillin-clavulanate (45 mg/kg/day) only for children aged 2 years or older without the above risk factors, with mild to moderate uncomplicated infections. 1, 2

For a 10 kg child, this translates to 225 mg of amoxicillin component twice daily (total 450 mg/day). 2

Practical Administration

The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which maintains efficacy while minimizing gastrointestinal side effects compared to older formulations. 3

For a 10 kg child requiring high-dose therapy:

• Using the 600 mg/5 mL suspension (ES-600 formulation): Give 3.75 mL twice daily 2
• This provides 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate 3

For a 10 kg child requiring standard-dose therapy:

• Using the 400 mg/5 mL suspension: Give 2.8 mL twice daily 2
• Alternatively, using 250 mg/5 mL suspension: Give 4.5 mL twice daily 2

Treatment Duration and Monitoring

• Continue treatment for 10 days for most respiratory infections, including pneumonia 1, 2
• Expect clinical improvement within 48-72 hours of starting therapy 2, 3
• If no improvement or worsening occurs after 72 hours, reassess the diagnosis and consider alternative pathogens or complications 2, 3

Critical Clinical Context

The high-dose regimen (90 mg/kg/day) achieves middle ear and sinus fluid concentrations adequate to overcome penicillin-resistant Streptococcus pneumoniae based on pharmacokinetic data from acute otitis media studies. 1 Research demonstrates that standard-dose amoxicillin (40-45 mg/kg/day) produces inadequate middle ear fluid concentrations to eradicate resistant pneumococci, particularly during viral coinfection. 4

Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms and promotes antimicrobial resistance. 3 The American Academy of Pediatrics explicitly recommends against subtherapeutic dosing, as it fails to achieve adequate tissue concentrations even against susceptible organisms. 3

Common Pitfalls to Avoid

• Do not use the 875 mg tablet formulation in children under 40 kg 5
• Verify the suspension concentration before calculating volume (125/31 mg/5 mL vs 250/62 mg/5 mL vs 600/42.9 mg/5 mL) to avoid dosing errors 3
• Do not underdose based on concerns about side effects—the incidence of adverse effects between standard and high-dose regimens is not significantly different 3, 6
• Administer at the start of meals to minimize gastrointestinal intolerance 5
• Shake suspension well before each use and discard after 14 days 5