What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a pediatric patient weighing 25kg with normal renal function?

Augmentin Dosing for 25kg Pediatric Patient

For a 25kg pediatric patient with normal renal function, administer Augmentin 45 mg/kg/day of the amoxicillin component divided into two daily doses (approximately 562.5 mg amoxicillin per dose, twice daily) for standard infections, or 90 mg/kg/day divided into two daily doses (approximately 1,125 mg amoxicillin per dose, twice daily) for severe infections or drug-resistant pathogens. 1, 2

Standard Dosing Regimen

Mild-to-Moderate Infections

• Administer 45 mg/kg/day of amoxicillin component divided twice daily, which equals approximately 1,125 mg total amoxicillin per day for this 25kg patient (562.5 mg per dose). 1, 3
• This can be given as 5 ml of the 250/62 suspension three times daily or adjusted to twice-daily dosing using appropriate formulation. 1
• The twice-daily regimen (45/6.4 mg/kg/day) demonstrates equivalent efficacy to three-times-daily dosing with improved compliance (82.8% vs 73.3%) and lower diarrhea rates (7.2% vs 10.7%). 3

Severe Infections or Drug-Resistant Pathogens

• For severe infections, persistent infections, or suspected penicillin-resistant Streptococcus pneumoniae, administer 90 mg/kg/day of amoxicillin component divided into two daily doses, totaling 2,250 mg amoxicillin per day for this 25kg patient (1,125 mg per dose). 1, 4, 5
• This high-dose formulation (90/6.4 mg/kg/day) effectively eradicates penicillin-resistant S. pneumoniae with MICs up to 2-4 mg/L. 4, 5
• The high-dose twice-daily formulation shows similar tolerability to conventional dosing with no significant increase in adverse events. 4, 5

Infection-Specific Considerations

Community-Acquired Pneumonia

• Use high-dose regimen (90 mg/kg/day) for suspected drug-resistant pathogens or recent antibiotic exposure within 4-6 weeks. 1
• Standard dosing (45 mg/kg/day) is appropriate for mild disease without recent antibiotic use. 1

Acute Otitis Media

• For recurrent or persistent AOM, use 90/6.4 mg/kg/day divided twice daily to cover β-lactamase-producing Haemophilus influenzae, Moraxella catarrhalis, and penicillin-resistant S. pneumoniae. 4, 5
• This formulation is specifically indicated after failure of standard amoxicillin therapy. 5

Skin and Soft Tissue Infections

• For impetigo or uncomplicated SSTI, use 25 mg/kg/day of amoxicillin component in 2 divided doses (approximately 312.5 mg per dose for this 25kg patient). 1

Practical Dosing Calculations

For 25kg Patient:

• Mild-moderate infections: 45 mg/kg/day = 1,125 mg/day ÷ 2 doses = 562.5 mg amoxicillin per dose, twice daily 2, 3
• Severe infections: 90 mg/kg/day = 2,250 mg/day ÷ 2 doses = 1,125 mg amoxicillin per dose, twice daily 2, 4

Available Formulations:

• Use 125/31 suspension (5 ml three times daily) for standard dosing, or 1
• Use 250/62 suspension (5 ml three times daily) for higher dosing needs, or 1
• Use high-dose formulation (90/6.4 mg/kg/day) when available for severe infections 4, 5

Treatment Duration

• Administer for 7-10 days for most infections, with duration based on clinical response and infection severity. 1
• Sinusitis may require up to 14 days depending on clinical response. 1

Critical Pitfalls to Avoid

• Do not use standard adult dosing for pediatric patients under 40kg—always calculate based on weight in mg/kg. 2, 6
• Do not underdose when drug-resistant pathogens are suspected—use the 90 mg/kg/day regimen for recent antibiotic exposure, daycare attendance, or treatment failure. 1, 4
• Ensure adequate dosing frequency—twice-daily dosing improves compliance over three-times-daily regimens without compromising efficacy. 3
• Account for the amoxicillin component specifically—dosing recommendations refer to the amoxicillin portion, not the total Augmentin weight. 1, 2