What is the typical dose of Augmentin (amoxicillin/clavulanate) for a child with a bacterial infection and normal renal function?

Augmentin Dosing in Pediatric Patients

For children with bacterial infections and normal renal function, the standard Augmentin dose is 45 mg/kg/day of the amoxicillin component divided into two doses for mild-to-moderate infections, or 90 mg/kg/day divided into two doses for severe infections or when resistant organisms are suspected, with a maximum daily dose of 4000 mg. 1, 2

Standard Dosing Algorithm

For Mild-to-Moderate Infections

• Children ≥3 months and <40 kg: 45 mg/kg/day of amoxicillin component divided every 12 hours 1, 3
• This provides adequate coverage for most susceptible pathogens including Streptococcus pneumoniae, Haemophilus influenzae (non-β-lactamase producing), and Streptococcus pyogenes 1
• Treatment duration: 7-10 days for most respiratory infections; 10 days specifically for pneumonia 1, 2

For Severe Infections or High-Risk Situations

• High-dose regimen: 90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate, divided into 2 doses 1, 2
• This achieves a 14:1 ratio of amoxicillin to clavulanate, which minimizes diarrhea while maintaining efficacy 2

Indications for High-Dose Therapy (90 mg/kg/day)

Use the high-dose regimen when ANY of these risk factors are present:

• Age <2 years 2
• Daycare attendance 2
• Recent antibiotic use within the past 30 days 1, 2
• Geographic area with >10% penicillin-resistant S. pneumoniae 1, 2
• Incomplete Haemophilus influenzae type b vaccination 2
• Moderate to severe illness 2
• Concurrent purulent acute otitis media 1
• Treatment failure with standard-dose amoxicillin 4

The high-dose formulation provides 90-92% predicted clinical efficacy against penicillin-resistant S. pneumoniae (MIC ≤2 mg/L) compared to 83-88% for standard dosing 4

Age-Specific Considerations

Infants <3 Months (12 weeks)

• Maximum dose: 30 mg/kg/day divided every 12 hours 3
• This lower dose accounts for incompletely developed renal function affecting amoxicillin elimination 3
• No dosing recommendations exist for infants <3 months with renal impairment 3

Children ≥3 Months

• Weight-based dosing is preferred over age-based dosing 1
• For children ≥40 kg, use adult dosing regimens 3

Specific Infection Types

Community-Acquired Pneumonia

• Outpatient children <5 years: 90 mg/kg/day in 2 doses 2
• Outpatient children ≥5 years: 90 mg/kg/day in 2 doses (maximum 4000 mg/day) 2
• Duration: 10 days 1, 2

Acute Otitis Media

• Standard: 45 mg/kg/day in 2 doses for uncomplicated cases 1
• High-dose: 90 mg/kg/day in 2 doses for severe AOM, bilateral AOM in children 6-23 months, or recent antibiotic exposure 2
• Duration: 10 days 2

Acute Bacterial Rhinosinusitis

• Standard: 45 mg/kg/day for children ≥2 years without risk factors 1
• High-dose: 80-90 mg/kg/day for children <2 years, in daycare, or with recent antibiotic use 1
• Duration: 10-14 days 2

Complicated Intra-Abdominal Infections

• Ampicillin-sulbactam (IV): 200 mg/kg/day of ampicillin component divided every 6 hours 5
• This is for hospitalized patients requiring intravenous therapy 5

Monitoring and Follow-Up

Clinical improvement should occur within 48-72 hours of starting therapy. 1, 2

If no improvement or worsening occurs after 72 hours:

• Reevaluate the diagnosis clinically and consider imaging 2
• Consider atypical pathogens and potentially add a macrolide 1
• Evaluate for complications or alternative diagnoses 2
• Consider switching antibiotics or obtaining cultures 2

Critical Dosing Considerations

Maximum Doses

• Absolute maximum: 4000 mg/day of amoxicillin component regardless of weight 1, 2
• Maximum single dose: 2000 mg per dose 2

Renal Impairment

• Children with GFR <30 mL/min should NOT receive the 875 mg tablet formulation 3
• For severe renal impairment (GFR 10-30 mL/min): 500 mg or 250 mg every 12 hours 3
• For GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3

Administration

• Take at the start of a meal to minimize gastrointestinal intolerance 3
• Shake oral suspension well before each use 3
• Reconstituted suspension must be discarded after 14 days 3

Common Pitfalls to Avoid

1. Using standard-dose when high-dose is indicated leads to treatment failure with resistant organisms 2
2. Verify suspension concentration (125/31 vs 250/62 mg/5mL) before calculating volume to avoid dosing errors 2
3. Do not use subtherapeutic doses as they fail to achieve adequate concentrations and promote antimicrobial resistance 2
4. Complete the full course even if symptoms improve before completion 1
5. Most upper respiratory tract infections are viral and do not require antibiotics at all—ensure bacterial infection criteria are met before prescribing 2

Alternative Formulations

For β-lactamase-producing organisms (H. influenzae, M. catarrhalis), Augmentin is specifically indicated over amoxicillin alone 1, 2

For severe penicillin allergy (anaphylaxis):

• Consider fluoroquinolones (ciprofloxacin) plus metronidazole 5
• Or aminoglycoside-based regimens 5

For non-anaphylactic penicillin allergy:

• Second- or third-generation cephalosporins (cefdinir, cefuroxime) 1