Augmentin Dosing for Bacterial Tonsillitis in a 3-Year-Old, 22 kg Child
For a 3-year-old child weighing 22 kg with bacterial tonsillitis, administer Augmentin at 90 mg/kg/day of the amoxicillin component divided into 2 doses, which equals approximately 990 mg twice daily (rounded to 1000 mg twice daily in practice). 1
Specific Dosing Calculation
The high-dose regimen of 90 mg/kg/day is the appropriate choice for this child, providing 22 kg × 90 mg/kg = 1980 mg total daily dose, divided into two doses of 990 mg each 1
Using the 400 mg/5 mL suspension (high-dose formulation with 14:1 ratio), this translates to approximately 12.4 mL twice daily 1, 2
The maximum single dose is 2000 mg regardless of weight, so this child's calculated dose is well within safe limits 1
Rationale for High-Dose Therapy
High-dose amoxicillin-clavulanate (90 mg/kg/day) is specifically indicated for this patient based on age alone. 1
Children under 2 years of age require high-dose therapy, and while this child is 3 years old, the American Academy of Pediatrics recommends high-dose therapy for Group A Streptococcal infections at 50-75 mg/kg/day, making the 90 mg/kg/day regimen appropriate for bacterial tonsillitis 1, 3
The high-dose formulation provides adequate coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms that may be present 1, 4
The 14:1 ratio formulation (90 mg/kg amoxicillin with 6.4 mg/kg clavulanate) causes significantly less diarrhea than other ratios while maintaining efficacy 1, 5
Treatment Duration and Administration
Complete a full 10-day course of therapy for bacterial tonsillitis 1, 3
Administer at the start of meals to minimize gastrointestinal intolerance and enhance clavulanate absorption 2
Clinical improvement should be evident within 48-72 hours; if no improvement occurs, reassess the diagnosis and consider alternative pathogens 1
Critical Dosing Considerations
Do not use the standard-dose regimen (45 mg/kg/day) for this indication, as it provides inadequate coverage and promotes antimicrobial resistance. 1
The FDA label specifies that for more severe infections and respiratory tract infections, higher doses are required 2
Using subtherapeutic doses leads to treatment failure with resistant organisms and increases the risk of complications 1
Verify the suspension concentration before dispensing—the 400 mg/57 mg per 5 mL formulation is specifically designed for high-dose twice-daily therapy 1, 2
Common Pitfalls to Avoid
Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amounts of clavulanic acid and are not equivalent 2
Do not use age-based dosing algorithms that recommend lower doses (such as 5 mL of 125/31 suspension three times daily for children 1-6 years), as these provide only 21 mg/kg/day—grossly inadequate for bacterial infections 1
Ensure compliance by emphasizing twice-daily dosing, which has been shown to have better adherence rates (82.8%) compared to three-times-daily regimens (73.3%) 6