Mixing Augmentin with Chocolate Milk for a 3-Year-Old
Yes, you can mix Augmentin (amoxicillin-clavulanate) oral suspension with chocolate milk for a 3-year-old who cannot tolerate it, as the FDA label explicitly states that amoxicillin-clavulanate may be taken without regard to meals, though absorption of clavulanate is enhanced when taken at the start of a meal. 1
Administration Guidelines
Mix the prescribed dose of Augmentin suspension directly into a small amount of chocolate milk (2-4 ounces) immediately before administration to ensure the child consumes the entire dose. 1
Administer the mixture at the start of a meal or snack to minimize gastrointestinal intolerance (nausea, vomiting, diarrhea) and enhance clavulanate absorption. 1
Have the child drink the entire mixture immediately after mixing, as you should not store antibiotic-milk mixtures for later use. 1
Dosing Considerations for a 3-Year-Old
The recommended dose for a 3-year-old is 45 mg/kg/day (based on amoxicillin component) divided every 12 hours for most infections including respiratory tract infections and otitis media. 1
Use either the 200 mg/5 mL or 400 mg/5 mL oral suspension formulation, as these are specifically designed for the every-12-hour regimen that causes significantly less diarrhea than every-8-hour dosing. 1
For less severe infections, 25 mg/kg/day every 12 hours may be appropriate, but for respiratory tract infections or more severe infections, the higher 45 mg/kg/day dose is preferred. 1
Important Caveats
Chocolate milk does not chemically interact with or inactivate amoxicillin-clavulanate, so mixing is safe from a pharmacological standpoint. 1
The primary concern with "intolerance" is gastrointestinal upset (nausea, vomiting, diarrhea), which is actually reduced by taking the medication with food or milk. 1
If the child experiences true allergic symptoms (rash, hives, difficulty breathing, facial swelling), stop the medication immediately and seek emergency care, as this represents a different problem than simple intolerance. 2, 3
Avoid mixing with large volumes of liquid that the child may not finish completely, as incomplete dosing can lead to treatment failure and resistance development. 1
Alternative Strategies if Mixing Fails
Consider switching to the chewable tablet formulation if the child is old enough and can chew tablets, as these may be more palatable than suspension. 1
Mix with other foods like applesauce, yogurt, or pudding if chocolate milk is ineffective, ensuring immediate consumption of the entire mixture. 1
If oral intolerance persists despite these measures, contact the prescribing physician to discuss alternative antibiotics (such as cefdinir or azithromycin) or consider whether the child requires parenteral therapy. 2, 3