What is the maximum dose of Augmentin (amoxicillin/clavulanic acid) for a 12-year-old boy?

Maximum Augmentin Dose for a 12-Year-Old Boy

For a 12-year-old boy, the maximum dose of Augmentin is 4000 mg per day of the amoxicillin component, typically administered as 90 mg/kg/day divided into two doses, not to exceed this daily maximum. 1, 2

Weight-Based Dosing Algorithm

For children weighing less than 40 kg:

• The standard maximum dose is 90 mg/kg/day of the amoxicillin component, divided into 2 doses 1, 2
• This translates to 45 mg/kg per dose given every 12 hours 1
• The absolute maximum is 4000 mg/day regardless of calculated weight-based dose 1

For children weighing 40 kg or more:

• Use adult dosing: 875 mg every 12 hours (1750 mg/day) for standard infections 2
• For severe infections or high-resistance areas: 2000 mg every 12 hours (4000 mg/day maximum) 3

Indication-Specific Maximum Dosing

For community-acquired pneumonia or severe respiratory infections:

• The Infectious Diseases Society of America recommends 90 mg/kg/day of the amoxicillin component in 2 divided doses 4, 1
• This high-dose regimen provides optimal coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms 3, 5

For acute otitis media (recurrent or persistent):

• High-dose formulation: 90 mg/kg/day divided into 2 doses 5, 6
• This dosing specifically targets β-lactamase-producing Haemophilus influenzae and penicillin-resistant S. pneumoniae 5

For mild to moderate infections:

• Standard dose: 45 mg/kg/day divided into 2 or 3 doses 1, 2
• Maximum single dose should not exceed 1000 mg for this regimen 2

Critical Dosing Considerations

The 4000 mg/day ceiling is absolute:

• Even if weight-based calculations exceed this amount, never prescribe more than 4000 mg/day of the amoxicillin component 1
• For a 50 kg child, 90 mg/kg/day would calculate to 4500 mg/day, but must be capped at 4000 mg/day 1

Twice-daily dosing is preferred over three-times-daily:

• Better adherence and similar efficacy compared to three-times-daily regimens 6
• Lower incidence of diarrhea with twice-daily dosing (7.2% vs 10.7%) 6

Common Pitfalls to Avoid

Do not underdose severe infections:

• Always use the 90 mg/kg/day regimen for documented or suspected resistant organisms 1, 3
• Recent antibiotic exposure (within 30 days) mandates high-dose therapy 1

Do not exceed maximum daily limits:

• The 4000 mg/day maximum applies to the amoxicillin component only, not the clavulanate 1, 2
• Patients with renal impairment (GFR <30 mL/min) should NOT receive the 875 mg dose 2

Administration timing matters:

• Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance 2
• Maintain consistent 12-hour intervals between doses for twice-daily regimens 2