Maximum Augmenting Dose in Pediatric Patients
The maximum augmenting dose of ampicillin-sulbactam (Augmentin) in pediatric patients is 200 mg ampicillin/kg/day divided every 6 hours, not to exceed the adult maximum daily dose. 1
Specific Dosing by Age Group
Infants
- 100-150 mg ampicillin/kg/day divided every 6 hours 1
- This represents the standard dosing range for younger infants
Children
- 100-200 mg ampicillin/kg/day divided every 6 hours 1
- The upper limit of 200 mg/kg/day represents the maximum augmenting dose for pediatric patients
- This higher dose range is used for more severe infections or when higher tissue penetration is needed
Critical Dosing Considerations
Weight-Based Limitations
- Pediatric doses should never exceed the normal adult dose, regardless of calculated weight-based dosing 1
- For children weighing more than 40 kg, adult dosing protocols should be followed 2, 3
Dosing Interval
- Ampicillin-sulbactam must be administered every 6 hours (four times daily) to maintain therapeutic levels 1
- This frequent dosing schedule is necessary due to the drug's pharmacokinetic profile in pediatric patients
Special Populations Requiring Dose Adjustment
Neonates
- Neonatal dosing differs significantly based on postnatal age and weight 1
- For ampicillin component alone: postnatal age ≤7 days and ≤2000 g receive 50 mg/kg/day divided every 12 hours; >2000 g receive 75 mg/kg/day divided every 8 hours 1
Critically Ill Patients
- Augmented renal clearance (ARC) can occur in critically ill pediatric patients, potentially requiring higher or more frequent dosing to achieve therapeutic targets 4
- Therapeutic drug monitoring should be considered in this population when available 4
Common Pitfalls to Avoid
- Do not use simple weight-based extrapolation from adult doses without considering developmental pharmacokinetics 5
- Avoid underdosing by failing to reach the 200 mg/kg/day maximum when treating serious infections in children <40 kg 1
- Never exceed adult maximum doses even if weight-based calculations suggest higher amounts 1
- Ensure proper dosing interval adherence (every 6 hours) as extended intervals may result in subtherapeutic levels 1