What is the maximum recommended dose of Augmentin (amoxicillin-clavulanate) for a pediatric patient weighing 31 kg?

Maximum Augmentin Dose for 31 kg Pediatric Patient

For a 31 kg pediatric patient, the maximum dose of Augmentin is 90 mg/kg/day of the amoxicillin component (2,790 mg/day total amoxicillin) with 6.4 mg/kg/day of clavulanate (198.4 mg/day total clavulanate), divided into two doses, not to exceed 2 grams of amoxicillin per dose. 1

Weight-Based Dosing Framework

Since this patient weighs 31 kg (less than 40 kg), pediatric weight-based dosing applies rather than adult fixed dosing 1:

Standard Dose (Mild to Moderate Infections)

• 45 mg/kg/day of amoxicillin component divided every 12 hours 1
• For 31 kg: 1,395 mg/day total = 697.5 mg per dose twice daily 1
• This applies to most ear/nose/throat, skin/skin structure, and genitourinary infections 1

High Dose (Severe Infections or Resistant Organisms)

• 90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day clavulanate, divided every 12 hours 2, 1
• For 31 kg: 2,790 mg/day total = 1,395 mg per dose twice daily 2, 1
• Maximum single dose is 2,000 mg (2 grams) of amoxicillin 1
• This patient's calculated dose (1,395 mg) is below the 2 gram maximum, so the full 90 mg/kg/day can be administered 1

Clinical Indications for High-Dose Therapy

High-dose amoxicillin-clavulanate (90 mg/kg/day) is recommended for 2:

• Moderate to severe illness 2
• Age younger than 2 years 2
• Child care attendance 2
• Recent antimicrobial use (within past 30 days) 2
• Geographic areas with high prevalence of nonsusceptible S. pneumoniae (>10% resistance) 2
• β-lactamase-producing H. influenzae or M. catarrhalis suspected 2

Formulation Considerations

The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which maintains adequate clavulanate levels while doubling the amoxicillin dose 3, 4:

• This formulation was specifically developed to address penicillin-resistant S. pneumoniae while minimizing gastrointestinal side effects from excessive clavulanate 3, 4
• The twice-daily dosing improves compliance compared to three-times-daily regimens 3, 5

Critical Dosing Pitfall

Never substitute two lower-strength tablets to achieve higher amoxicillin doses, as this results in excessive clavulanate administration and increased gastrointestinal adverse effects 6:

• Use the appropriate high-dose formulation (Augmentin ES-600 for suspension or appropriate tablet strength) 3, 4

Duration of Therapy

• Minimum 48-72 hours beyond symptom resolution or bacterial eradication 1
• At least 10 days for Streptococcus pyogenes infections to prevent acute rheumatic fever 1
• 7-10 days for most respiratory tract infections 7