Co-Amoxiclav 228.5/5 mg Dosing Assessment for a 7-Year-Old
This dose is INCORRECT and grossly inadequate for a 7-year-old child.
For a 7-year-old child, the appropriate co-amoxiclav dosing is 5 ml of 250/62 suspension three times daily (providing approximately 250 mg amoxicillin per dose, totaling 750 mg daily), NOT 228.5/5 mg. 1, 2
Understanding the Dosing Error
The "228.5/5" notation appears to be a misunderstanding of co-amoxiclav formulations. The correct age-based dosing algorithm for pediatric patients is:
- Children 1-6 years: 5 ml of 125/31 suspension three times daily 1, 2
- Children 7-12 years: 5 ml of 250/62 suspension three times daily 1, 2
- Children 12-18 years: 1 tablet of 250/125 three times daily 1, 2
The 250/62 formulation means 250 mg amoxicillin and 62 mg clavulanic acid per 5 ml, which is specifically indicated for children over 6 years of age. 1
High-Dose Regimen Considerations
For certain infections requiring high-dose therapy (particularly respiratory tract infections with risk of resistant organisms), the dosing changes significantly:
- High-dose regimen: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses 1, 2
- This provides a 14:1 ratio of amoxicillin to clavulanate, which causes less diarrhea than other preparations while maintaining efficacy 1, 3, 4
High-dose therapy is indicated for children with:
- Age <2 years 1
- Daycare attendance 1, 2
- Recent antibiotic use within 30 days 1
- Incomplete Haemophilus influenzae type b vaccination 1
- Geographic areas with high prevalence (>10%) of penicillin-resistant Streptococcus pneumoniae 1
- Moderate to severe illness 1
Critical Dosing Pitfalls to Avoid
Always verify the suspension concentration (125/31 vs 250/62) before calculating volume to avoid dosing errors. 1 Using adult formulations for children or incorrect age-based formulations can lead to significant underdosing or overdosing. 2
Subtherapeutic doses fail to achieve adequate serum and tissue concentrations to overcome even susceptible organisms and promote antimicrobial resistance. 1 Treatment failure with resistant organisms is inevitable when standard doses are not used. 1
Administration Guidance
- Co-amoxiclav may be taken with or without food, though administration at the start of meals improves gastrointestinal tolerability 2, 5
- Absorption of clavulanate potassium is enhanced when administered at the start of a meal 5
- Common adverse effects include diarrhea, nausea, vomiting, and rash 1, 2
- Diarrhea is generally less frequent with twice-daily than three-times-daily dosing 3
Renal Impairment Considerations
For children with altered renal function, the dose should be significantly reduced due to renal elimination of both amoxicillin and clavulanic acid. 1 In patients with established renal insufficiency, prolonging the dosing interval according to creatinine clearance is essential to avoid accumulation. 1