Augmentin Dosing for 9.9 kg Pediatric Patient with Otitis Media
For a 9.9 kg child with acute otitis media, prescribe high-dose Augmentin (amoxicillin-clavulanate) 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, divided into two doses every 12 hours for 10 days, which equals approximately 445 mg of amoxicillin twice daily (890 mg total daily dose). 1, 2
Specific Dose Calculation
- Total daily dose: 9.9 kg × 90 mg/kg = 891 mg amoxicillin component per day 1, 2
- Individual dose: 445 mg amoxicillin twice daily (every 12 hours) 1, 2
- Clavulanate component: 9.9 kg × 6.4 mg/kg/day = 63.4 mg total daily (31.7 mg per dose) 1, 2
- Duration: 10 days of therapy 1, 2
Rationale for High-Dose Therapy
High-dose amoxicillin-clavulanate is indicated as first-line therapy when the child has received amoxicillin in the past 30 days, has concurrent purulent conjunctivitis, or has recurrent AOM unresponsive to amoxicillin. 1 If none of these conditions apply, standard high-dose amoxicillin alone (80-90 mg/kg/day) would be first-line. 1
The high-dose formulation achieves:
- 91-92% predicted clinical efficacy in children with acute bacterial infections 1
- Eradication of 96% of Streptococcus pneumoniae isolates, including 91% of penicillin-resistant strains (MIC 2-4 mcg/mL) 3
- Eradication of 90% of Haemophilus influenzae, including 86% of beta-lactamase-producing strains 3
Practical Prescribing Details
Augmentin ES-600 suspension (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) is the appropriate formulation for achieving high-dose therapy in young children. 4 For this 9.9 kg patient:
- Prescribe 3.7 mL twice daily (every 12 hours) 4
- Administer at the start of meals to minimize gastrointestinal intolerance 5
- Shake suspension well before each use 5
- Refrigeration is preferable but not required; discard after 14 days 5
Reassessment and Treatment Failure
Reassess the patient if symptoms worsen or fail to improve within 48-72 hours. 1 At that point:
- If already on high-dose amoxicillin-clavulanate and failing, consider intramuscular ceftriaxone 50 mg/kg daily for 3 days 1
- A 3-day course of ceftriaxone is superior to a 1-day regimen for treatment failures 1
- Tympanocentesis with culture should be considered after multiple antibiotic failures 1
Common Pitfalls to Avoid
Do not use standard-dose amoxicillin-clavulanate (45 mg/kg/day) formulations, as they provide inadequate coverage against resistant S. pneumoniae. 1 The conventional formulation achieves only 91-92% efficacy compared to the same rate with high-dose therapy, but high-dose is specifically needed for resistant organisms. 1
Avoid prescribing azithromycin or other macrolides as first-line therapy, as they demonstrate significantly lower bacteriologic eradication rates (70% vs 94% for amoxicillin-clavulanate) and clinical success rates (81% vs 91%). 6
Do not prescribe trimethoprim-sulfamethoxazole or erythromycin-sulfisoxazole, as pneumococcal resistance to these agents is substantial, with bacteriologic failure rates of 20-25%. 1
Adverse Effects and Monitoring
The most common adverse effects are:
- Diarrhea: occurs in approximately 25% of patients on high-dose therapy versus 15% on placebo 1
- Diaper dermatitis: occurs in 51% versus 35% on placebo 1
- Twice-daily dosing produces less diarrhea than three-times-daily administration 7
Pain management with acetaminophen or ibuprofen should be provided regardless of antibiotic use, especially during the first 24 hours. 2