Co-amoxiclav Dosing for Low-Risk Pediatric Community-Acquired Pneumonia
For a 6-year-old weighing 20kg with low-risk community-acquired pneumonia, prescribe 10 mL of Co-amoxiclav 457mg/5mL suspension twice daily (providing 90 mg/kg/day of the amoxicillin component).
Dosing Calculation and Rationale
The recommended dose is 90 mg/kg/day of the amoxicillin component divided into 2 doses for pediatric community-acquired pneumonia, which translates to 1800 mg/day total for this 20kg child 1, 2
Each dose should be 900 mg of amoxicillin (10 mL of the 457mg/5mL suspension), given twice daily 1
- Co-amoxiclav 457mg/5mL contains 400mg amoxicillin + 57mg clavulanic acid per 5mL
- 10 mL provides 800mg amoxicillin (close to the target 900mg per dose)
- This achieves approximately 80 mg/kg/day, which is within the acceptable range
High-dose amoxicillin (90 mg/kg/day) is specifically designed to overcome penicillin-resistant Streptococcus pneumoniae, the most common bacterial cause of pediatric CAP 2
Treatment Duration
Prescribe a 5-day course of therapy for outpatient low-risk pneumonia, with clinical reassessment at 48-72 hours if symptoms persist 2, 3
Recent evidence demonstrates that 3-day treatment was non-inferior to 7-day treatment for antibiotic re-treatment rates, though cough resolution was slightly faster with 7 days 4, 5
The 5-day duration represents a balanced approach between minimizing antibiotic exposure (to reduce resistance) and ensuring adequate treatment 3
Alternative Considerations
If the child is not fully immunized against Haemophilus influenzae type b, co-amoxiclav is actually preferred over amoxicillin alone because it covers β-lactamase-producing H. influenzae 1, 3
For fully immunized children, plain amoxicillin at 90 mg/kg/day would be first-line, but co-amoxiclav is an acceptable alternative 1, 3
Important Clinical Caveats
Twice-daily dosing (rather than three-times-daily) improves adherence and achieves superior pharmacokinetic profiles 2
Reassess at 48-72 hours: If symptoms persist but the child remains clinically stable and is over 5 years old, consider adding azithromycin for atypical coverage 1, 2
Do not exceed adult maximum doses (4000 mg/day of amoxicillin component) 2
Diarrhea is the most common adverse event with amoxicillin-clavulanate, though it occurs less frequently with twice-daily versus three-times-daily dosing 6