Augmentin Dosing for 14 kg Pediatric Patient with Otitis Media
For a 14 kg child with acute otitis media, administer high-dose amoxicillin-clavulanate at 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, divided into 2 doses daily, which equals 630 mg of amoxicillin with 44.8 mg of clavulanate twice daily (approximately 12.6 mL of the ES-600 formulation twice daily). 1
Rationale for High-Dose Amoxicillin-Clavulanate
The American Academy of Pediatrics recommends high-dose amoxicillin-clavulanate as first-line therapy for children younger than 2 years old (which includes most 14 kg patients, typically around 1-2 years of age) due to increased risk of resistant organisms. 1 This formulation provides superior coverage against:
- β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 1
- Penicillin-intermediate and resistant Streptococcus pneumoniae strains 1, 2
- Achieves middle ear fluid concentrations exceeding the minimum inhibitory concentration for approximately 87% of S. pneumoniae isolates 1
Specific Dosing Calculation
Total daily dose:
- Amoxicillin: 90 mg/kg/day × 14 kg = 1,260 mg/day
- Clavulanate: 6.4 mg/kg/day × 14 kg = 89.6 mg/day
- Divided into 2 doses: 630 mg amoxicillin with 44.8 mg clavulanate twice daily 1
The critical 14:1 ratio formulation (amoxicillin to clavulanate) minimizes gastrointestinal side effects, particularly diarrhea, compared to older formulations. 1, 3
Additional Indications for High-Dose Therapy
High-dose amoxicillin-clavulanate is specifically indicated if the patient has:
- Received amoxicillin within the previous 30 days 1
- Concurrent purulent conjunctivitis 1
- Attends daycare 1
- Failed initial amoxicillin therapy 1
Treatment Duration and Monitoring
- Standard treatment duration: 10 days 1
- Reassess at 48-72 hours for clinical improvement 1
- If no improvement occurs after 48-72 hours, consider treatment failure and switch to ceftriaxone (50 mg/kg IM/IV daily) 1
Administration Instructions
- Administer at the start of meals to minimize gastrointestinal intolerance 4
- Shake oral suspension well before each use 4
- The suspension can be mixed with formula, milk, fruit juice, or water if needed, but must be taken immediately after mixing 4
- Refrigeration is preferable but not required; discard unused suspension after 14 days 4
Common Pitfalls to Avoid
Critical error: Using older amoxicillin-clavulanate formulations with higher clavulanate ratios (such as 40/10 mg/kg/day) causes significantly more diarrhea and should be avoided. 1 The 14:1 ratio formulation (90/6.4 mg/kg/day) is essential for tolerability. 1
Inadequate dosing: Standard-dose amoxicillin (45 mg/kg/day) is insufficient for resistant organisms and should not be used in high-risk patients like those under 2 years of age. 1
Evidence Quality
The recommendation is based on American Academy of Pediatrics guidelines that demonstrate superior bacterial eradication with high-dose amoxicillin-clavulanate compared to alternatives, with 96% eradication of S. pneumoniae versus 80.4% with azithromycin. 1 Clinical trials confirm equivalent efficacy between twice-daily and three-times-daily dosing, with improved compliance and lower adverse event rates with twice-daily administration. 3, 5