What is the recommended dose of Moxikind CV (amoxicillin and clavulanic acid) for pediatric patients?

Moxikind CV Dosing in Pediatric Patients

For pediatric patients, Moxikind CV (amoxicillin-clavulanate) should be dosed at 90 mg/kg/day of the amoxicillin component divided into 2 doses (maximum 4000 mg/day) for most infections, particularly respiratory tract infections, acute otitis media, and sinusitis. 1

Standard Dosing Algorithm

Age-Based Dosing for Routine Infections

For children with mild to moderate infections without risk factors for resistant organisms:

• Less than 1 year (1-12 months): 2.5 ml of 125/31 suspension three times daily 1
• 1-6 years: 5 ml of 125/31 suspension three times daily 1
• 7-12 years: 5 ml of 250/62 suspension three times daily 1
• 12-18 years: 1 tablet (250/125) three times daily 1

High-Dose Regimen (Preferred for Most Infections)

The high-dose regimen of 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate divided into 2 doses is strongly recommended for children with any of the following risk factors 1:

• Age less than 2 years 1
• Daycare attendance 1
• Recent antibiotic use within the past 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

This high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which causes less diarrhea than other preparations while maintaining superior efficacy against resistant organisms 1, 2.

Indication-Specific Dosing

Respiratory Tract Infections

• Community-acquired pneumonia: 90 mg/kg/day of amoxicillin component in 2 divided doses for 10 days 1
• Acute bacterial rhinosinusitis: 90 mg/kg/day divided twice daily for 10-14 days 1
• Acute otitis media: 90 mg/kg/day divided twice daily for 10 days, particularly for severe, bilateral, or recurrent cases 1

Alternative Lower-Dose Regimen

For β-lactamase producing organisms in children without high-resistance risk factors, an alternative regimen of 45 mg/kg/day in 3 divided doses may be used 1. However, the 90 mg/kg/day twice-daily regimen is preferred as it provides better coverage and improved compliance 1.

Maximum Dosing Limits

• Maximum single dose: 2 grams per dose regardless of weight 1
• Maximum daily dose: 4000 mg (4 g) of amoxicillin component per day 1

Intravenous Dosing

For severe infections requiring parenteral therapy: 30 mg/kg three times daily IV 1

Treatment Duration

• Most respiratory infections: 7-10 days 1
• Pneumonia and acute otitis media: 10 days 1
• Acute bacterial rhinosinusitis: 10-14 days 1
• Continue therapy for at least 48-72 hours after the patient becomes asymptomatic 3

Critical Clinical Considerations

Monitoring Response

Clinical improvement should be evident within 48-72 hours of starting therapy 1. If no improvement or worsening occurs after 72 hours, reevaluation is necessary with consideration of:

• Atypical pathogens 1
• Complications requiring imaging 1
• Alternative diagnoses 1
• Treatment failure requiring antibiotic change 1

Common Pitfalls to Avoid

1. Verify suspension concentration (125/31 vs 250/62) before calculating volume to prevent dosing errors 1
2. Do not use subtherapeutic doses, as they fail to achieve adequate tissue concentrations and promote antimicrobial resistance 1
3. Avoid using standard doses when high-dose therapy is indicated, as this leads to treatment failure with resistant organisms 1
4. Ensure most URTIs are actually bacterial before prescribing, as the majority are viral and do not benefit from antibiotics 1

Renal Impairment Adjustments

For children with severe renal impairment (GFR <30 mL/min), dosing adjustments are required 3:

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 3
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3

Administration Instructions

• Administer at the start of meals to minimize gastrointestinal intolerance 3
• Shake oral suspension well before each use 3
• Refrigeration is preferable but not required 3
• Discard unused reconstituted suspension after 14 days 3

Tolerability Profile

The high-dose formulation (90/6.4 mg/kg/day) demonstrates similar tolerability to conventional formulations, with diarrhea being less frequent with twice-daily dosing compared to three-times-daily regimens 1, 2. Common adverse effects include mild gastrointestinal disturbances, with a low overall incidence of serious adverse events 2.