What is the pediatric dose of amoxicillin-clavulanic acid (amoxiclav) and sulbactam (in combination with ampicillin)?

Pediatric Dosing for Injectable Amoxicillin-Clavulanate and Ampicillin-Sulbactam

Injectable Amoxicillin-Clavulanate (Amoxiclav) - Intravenous Dosing

For pediatric patients requiring IV amoxicillin-clavulanate, administer 30 mg/kg three times daily (every 8 hours) based on the amoxicillin component, regardless of age. 1

Specific IV Dosing Guidelines:

• Standard IV dose: 100-200 mg/kg/day of the amoxicillin component, divided every 6-8 hours 2
• Maximum dose: 4000 mg/day of amoxicillin component 1
• Administration: Given as IV infusion over 15-30 minutes 2

Clinical Context for IV Therapy:

• IV therapy is indicated for severe infections, inability to tolerate oral medications, or hospitalized patients with complicated intra-abdominal infections 2
• For complicated intra-abdominal infections specifically, the dosing is 200 mg/kg/day of amoxicillin component divided every 6 hours 2

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Injectable Ampicillin-Sulbactam - Intravenous Dosing

For pediatric patients 1 year of age or older, administer 300 mg/kg/day (total drug content) via IV infusion in equally divided doses every 6 hours, which corresponds to 200 mg/kg/day ampicillin plus 100 mg/kg/day sulbactam. 3

Specific Dosing Details:

• Pediatric dose ≥1 year: 300 mg/kg/day total (ampicillin + sulbactam content) divided every 6 hours 3
  • This equals 200 mg/kg/day ampicillin + 100 mg/kg/day sulbactam 3
• Pediatric patients ≥40 kg: Dose according to adult recommendations (1.5-3 g every 6 hours) 3
• Maximum sulbactam dose: Do not exceed 4 grams of sulbactam per day 3

Administration Guidelines:

• Give by slow IV injection over at least 10-15 minutes, or as IV infusion over 15-30 minutes when diluted in 50-100 mL of compatible diluent 3
• The course of IV therapy should not routinely exceed 14 days 3
• Most children transition to oral antimicrobials following initial IV treatment 3

Renal Impairment Adjustments:

For patients with renal impairment, adjust dosing frequency based on creatinine clearance 3:

• CrCl ≥30 mL/min: Every 6-8 hours
• CrCl 15-29 mL/min: Every 12 hours
• CrCl 5-14 mL/min: Every 24 hours

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Critical Dosing Considerations

Common Pitfalls to Avoid:

• Do not confuse component dosing: For ampicillin-sulbactam, the 300 mg/kg/day represents TOTAL drug content (ampicillin + sulbactam), not just the ampicillin component 3
• Verify weight-based calculations: Always calculate doses based on actual body weight in kilograms 2
• Do not underdose: β-lactam antibiotic dosages should be maximized if undrained intra-abdominal abscesses may be present 2

Monitoring Requirements:

• Monitor renal function when using ampicillin-sulbactam, as both components are renally eliminated 3
• For complicated intra-abdominal infections, obtain intraoperative Gram stains and cultures to guide therapy 2
• Expect clinical improvement within 48-72 hours; if no improvement occurs, reevaluate diagnosis and consider alternative pathogens 1

Safety Considerations:

• The safety and efficacy of ampicillin-sulbactam via intramuscular injection in pediatric patients have NOT been established—use IV route only 3
• Amoxicillin-clavulanate is generally well tolerated with mild gastrointestinal disturbances being the most common adverse effect 4
• Antibiotic serum concentrations should be monitored when using aminoglycosides or vancomycin in combination regimens 2