Amoxicillin-Clavulanate (Amoxclav) Syrup Dosing for Children 5-15 kg
For children weighing 5-15 kg, use the 125/31 mg per 5 mL suspension at 2.5 mL twice daily for standard infections, or 2.5 mL three times daily for severe infections or those with risk factors for resistant organisms. 1, 2
Weight-Based Dosing Table
Standard Dosing Regimen (45 mg/kg/day divided BID)
| Weight | Volume per Dose | Frequency | Total Daily Amoxicillin |
|---|---|---|---|
| 5 kg | 2.5 mL | Twice daily | 225 mg |
| 7 kg | 2.5 mL | Twice daily | 225 mg |
| 10 kg | 2.5 mL | Twice daily | 225 mg |
| 12 kg | 2.5 mL | Twice daily | 225 mg |
| 15 kg | 2.5 mL | Twice daily | 225 mg |
Use 125/31 mg per 5 mL suspension (each 2.5 mL contains 62.5 mg amoxicillin) 1, 2
High-Dose Regimen (90 mg/kg/day divided BID)
For children with risk factors (age <2 years, daycare attendance, recent antibiotic use within 30 days, incomplete H. influenzae type b vaccination, moderate-to-severe illness, or areas with >10% penicillin-resistant S. pneumoniae):
| Weight | Volume per Dose | Frequency | Total Daily Amoxicillin |
|---|---|---|---|
| 5 kg | 5 mL | Twice daily | 450 mg |
| 7 kg | 7 mL | Twice daily | 630 mg |
| 10 kg | 10 mL | Twice daily | 900 mg |
| 12 kg | 12 mL | Twice daily | 1080 mg |
| 15 kg | 15 mL | Twice daily | 1350 mg |
Use 200/28.5 mg per 5 mL suspension for high-dose regimen 1, 2
Critical Dosing Considerations
Age-Specific Guidelines
Infants <3 months (typically <5 kg): Use 30 mg/kg/day divided every 12 hours using the 125/31 mg per 5 mL suspension only, as experience with higher concentration formulations is limited in this age group 2
Infants 3-12 months (typically 5-10 kg): Standard dose is 2.5 mL of 125/31 suspension three times daily for routine infections 1
Children 1-6 years (typically 10-20 kg): Standard dose is 5 mL of 125/31 suspension three times daily, but for weights 5-15 kg, use 2.5 mL dosing as outlined above 1
When to Use High-Dose Regimen
High-dose amoxicillin-clavulanate (90 mg/kg/day with 6.4 mg/kg/day clavulanate in 2 divided doses) is mandatory for: 1, 3
- Children <2 years of age
- Daycare attendance
- Antibiotic use within previous 30 days
- Incomplete H. influenzae type b vaccination (<3 doses)
- Moderate to severe illness presentation
- Geographic areas with >10% penicillin-resistant S. pneumoniae
- Concurrent purulent conjunctivitis or acute otitis media
- Failed initial amoxicillin therapy
Formulation Selection
125/31 mg per 5 mL suspension: For standard dosing in all weights 5-15 kg, and for infants <3 months 1, 2
200/28.5 mg per 5 mL suspension: For high-dose regimen (90 mg/kg/day) in children with risk factors, providing the preferred 14:1 ratio of amoxicillin to clavulanate 1, 4
The 14:1 ratio formulation causes significantly less diarrhea than other amoxicillin-clavulanate preparations while maintaining efficacy 1
Administration Guidelines
Give at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 2
Treatment duration: 10 days for acute otitis media, bacterial sinusitis, and pneumonia 1, 3
Clinical improvement should occur within 48-72 hours; if no improvement or worsening, reevaluate diagnosis and consider switching antibiotics 1, 3
Common Pitfalls to Avoid
Never substitute two 250/125 mg tablets for one 500/125 mg tablet, as they contain different amounts of clavulanate 2
Verify suspension concentration (125/31 vs 200/28.5 vs 250/62) before calculating volume to avoid dosing errors 1
Do not use standard-dose therapy when high-dose is indicated—this leads to treatment failure with resistant organisms and promotes antimicrobial resistance 1
For children weighing exactly 15 kg transitioning to higher weight brackets, continue using the 15 kg dosing until they clearly exceed this weight 1, 2
Most upper respiratory tract infections are viral and do not require antibiotics; ensure bacterial infection criteria are met before prescribing 1