Co-Amoxiclav Syrup Dosing in Pediatrics
The recommended dosage of co-amoxiclav syrup is 45 mg/kg/day of the amoxicillin component divided into 2 doses for standard infections, or 80-90 mg/kg/day with 6.4 mg/kg/day of clavulanate divided into 2 doses for high-risk situations or severe infections. 1
Standard Dosing Framework
For uncomplicated infections in children ≥2 years old without recent antibiotic exposure:
- 45 mg/kg/day of amoxicillin component in 2 divided doses 1, 2
- This applies to mild-to-moderate respiratory infections including acute otitis media and uncomplicated sinusitis 1
- Maximum single dose is 2000 mg 3
Age-Based Suspension Dosing
For practical administration using standard suspension formulations 1:
- <1 year: 2.5 ml/kg of 125/31 suspension three times daily 1
- 1-6 years: 5 ml of 125/31 suspension three times daily 1
- >6 years: 5 ml of 250/62 suspension three times daily 1
High-Dose Regimen Indications
Use 80-90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses when any of these risk factors are present: 1, 2
- Age <2 years 1, 2
- Attendance at childcare 1, 2
- Antibiotic use within previous 30 days 1, 2
- Moderate-to-severe illness 1, 2
- Concurrent conjunctivitis (otitis-conjunctivitis syndrome) 1
- Geographic areas with >10% penicillin-nonsusceptible S. pneumoniae 1
Critical Dosing Considerations
The clavulanate component must be maintained at 6.4 mg/kg/day for high-dose regimens to ensure adequate β-lactamase inhibition. 1, 3 This ratio (14:1 amoxicillin to clavulanate) is specifically designed to minimize diarrhea while providing coverage against β-lactamase-producing H. influenzae and M. catarrhalis 1, 2.
Common Pitfalls to Avoid
- Do not use standard-dose amoxicillin-clavulanate for high-risk patients - the clavulanate concentration will be inadequate 1
- Do not exceed 2000 mg amoxicillin per single dose regardless of weight 3, 2
- Research shows that standard 40 mg/kg/day dosing is inadequate for resistant S. pneumoniae, particularly during viral coinfection 4
Duration of Therapy
- Acute otitis media: 10 days for children <2 years; 5-7 days for older children with uncomplicated cases 1
- Acute bacterial sinusitis: Minimum 10 days total, continuing 7 days after symptom resolution 1, 3
- Most other infections: 7-10 days 2
Special Clinical Scenario: Treatment Failure
If the patient fails to improve after 48-72 hours on standard-dose amoxicillin-clavulanate, escalate to ceftriaxone 50 mg/kg IM or IV for 3 days 1. This provides coverage for multidrug-resistant organisms while awaiting culture results.