What is the appropriate dose of Augmentin (amoxicillin/clavulanate) for a 5-year-old female patient weighing 54.2 pounds with pneumonia?

Augmentin Dosing for Pneumonia in a 5-Year-Old, 54.2 lb Child

For this 5-year-old patient weighing 54.2 pounds (24.6 kg) with pneumonia, administer Augmentin 90 mg/kg/day of the amoxicillin component divided into 2 doses, which equals approximately 1,100 mg twice daily (total 2,200 mg/day), given for 10 days. 1, 2

Weight-Based Calculation

• Patient weight: 54.2 pounds = 24.6 kg
• High-dose regimen: 90 mg/kg/day ÷ 2 doses = 45 mg/kg per dose 1, 2
• Calculated dose: 24.6 kg × 45 mg/kg = 1,107 mg per dose (approximately 1,100 mg twice daily) 1, 2

Formulation Selection

This child should receive the 400 mg/57 mg per 5 mL oral suspension, administered as 13.75 mL (approximately 14 mL) twice daily. 3

• Alternative: If using chewable tablets, give two 400 mg/57 mg tablets twice daily 3
• The high-dose formulation (90 mg/kg/day) is specifically indicated for community-acquired pneumonia in fully immunized children to provide optimal coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms. 1, 2, 4

Rationale for High-Dose Regimen

The 90 mg/kg/day dosing (rather than 45 mg/kg/day) is preferred for pneumonia because: 1, 2

• Provides adequate coverage for penicillin-resistant S. pneumoniae, the most common bacterial cause of pneumonia in this age group 1
• Maintains therapeutic concentrations against β-lactamase-producing Haemophilus influenzae 1, 2
• The IDSA/PIDS guidelines specifically recommend this higher dose for presumed bacterial pneumonia in children ≥5 years old 1

Treatment Duration and Monitoring

Complete a full 10-day course of therapy. 1, 2

• Clinical improvement should be evident within 48-72 hours; if no improvement occurs, reevaluation and further investigation are necessary. 1, 2
• Fever typically resolves within 24-48 hours for pneumococcal pneumonia, though cough may persist longer 1
• If the patient deteriorates or shows no improvement by 48-72 hours, consider atypical pathogens and potentially add a macrolide 1

Administration Recommendations

Administer at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects. 3

• The twice-daily regimen is preferred over three-times-daily dosing as it improves adherence and is associated with significantly less diarrhea 3
• Ensure adequate hydration throughout treatment 3

Critical Considerations

Common pitfall: Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different ratios of clavulanate and are not equivalent. 3

• The absolute maximum daily dose of amoxicillin is 4,000 mg/day regardless of weight 2, 4
• For this 24.6 kg patient, the calculated dose (2,200 mg/day) is well below this maximum 2, 4
• If the patient has received antibiotics within the past 3 months, the high-dose regimen is particularly important due to increased risk of resistant organisms. 2