Is Augmentin (amoxicillin/clavulanate) 600/5, given at 3.75 mL twice daily for 10 days, an appropriate dose for a 2-year-old child weighing 27 pounds?

Augmentin 600/5 Dosing Assessment for 2-Year-Old, 27 Pounds

No, this dosing is inappropriate and potentially dangerous—the prescribed dose of 3.75 mL twice daily delivers only 450 mg/day of amoxicillin, which is significantly below the recommended minimum of 545 mg/day for this child's weight.

Correct Dose Calculation

Weight conversion and dosing requirements:

• 27 pounds = 12.3 kg 1
• For mild-to-moderate infections: 45 mg/kg/day of amoxicillin component = 554 mg/day (approximately 4.6 mL twice daily) 2, 1
• For severe infections or high-resistance areas: 90 mg/kg/day = 1,107 mg/day (approximately 9.2 mL twice daily) 2, 1

What the current prescription actually delivers:

• Augmentin 600/5 contains 600 mg amoxicillin per 5 mL 1
• 3.75 mL twice daily = 450 mg amoxicillin per dose × 2 = 900 mg/day total
• This calculates to only 73 mg/kg/day—falling between standard and high-dose recommendations but delivered as an incorrect volume 1

Critical Dosing Error

The fundamental problem is the volume calculation:

• To achieve 45 mg/kg/day (554 mg/day): Give approximately 2.3 mL twice daily 1
• To achieve 90 mg/kg/day (1,107 mg/day): Give approximately 4.6 mL twice daily 2, 1
• The prescribed 3.75 mL twice daily represents neither standard nor high-dose therapy appropriately 1

Appropriate Dosing Recommendations

For standard respiratory infections (otitis media, sinusitis, lower respiratory tract infections):

• Use 45 mg/kg/day divided every 12 hours = 2.3 mL of Augmentin 600/5 twice daily for 10 days 2, 1

For severe infections or areas with high pneumococcal resistance:

• Use 90 mg/kg/day divided every 12 hours = 4.6 mL of Augmentin 600/5 twice daily for 10 days 2, 1

Clinical Context and Treatment Duration

Expected clinical response:

• Clinical improvement should occur within 48-72 hours 2
• If no improvement by 72 hours, reevaluation is necessary to consider resistant pathogens or alternative diagnoses 2

Standard treatment duration:

• 10 days for acute otitis media and community-acquired pneumonia 2
• 7-10 days for other respiratory infections 2

Common Pitfalls to Avoid

Dosing calculation errors:

• Always calculate based on the child's weight in kilograms, not pounds 1
• Verify the concentration of the specific Augmentin formulation being used (600 mg/5 mL in this case) 1
• The 600/5 formulation (Augmentin ES-600) was specifically developed to provide higher amoxicillin doses while maintaining lower clavulanate to reduce gastrointestinal side effects 3

Formulation confusion:

• Do not substitute different Augmentin formulations without recalculating doses, as they contain different ratios of amoxicillin to clavulanate 1
• The 600/5 suspension provides a 14:1 ratio specifically designed for high-dose therapy 3