What is the recommended dosage of Augmentin (amoxicillin/clavulanic acid) for an 8-year-old, 16kg female patient with normal renal function and no known allergies to penicillin or other beta-lactam antibiotics?

Augmentin Dosing for an 8-Year-Old, 16kg Female Patient

Direct Recommendation

For this 16kg child, administer Augmentin 45 mg/kg/day of the amoxicillin component divided into 2 doses (360 mg twice daily) for mild to moderate infections, or 90 mg/kg/day divided into 2 doses (720 mg twice daily) for severe infections or areas with high pneumococcal resistance. 1

Weight-Based Dosing Algorithm

Standard Dosing (Mild to Moderate Infections)

• Calculate 45 mg/kg/day: For a 16kg child, this equals 720 mg/day total, administered as 360 mg twice daily 1
• This provides adequate coverage for most susceptible pathogens including Streptococcus pneumoniae, Haemophilus influenzae (non-β-lactamase producing), and Streptococcus pyogenes 1
• Appropriate for uncomplicated respiratory tract infections, skin infections, and genitourinary infections 1

High-Dose Regimen (Severe Infections or High Resistance)

• Calculate 90 mg/kg/day: For a 16kg child, this equals 1440 mg/day total, administered as 720 mg twice daily 1
• The Infectious Diseases Society of America recommends this higher dose for:
  • Community-acquired pneumonia in areas with >10% penicillin-resistant S. pneumoniae 1
  • Children <2 years old 1
  • Recent antibiotic exposure within the past 30 days 1
  • Children attending daycare 1
  • Severe infections requiring hospitalization 1

Indication-Specific Considerations

Respiratory Tract Infections

• For mild to moderate pneumonia: 45 mg/kg/day (360 mg twice daily) 1
• For severe pneumonia or high pneumococcal resistance areas: 90 mg/kg/day (720 mg twice daily) 1
• The high-dose formulation (90 mg/kg/day) provides optimal coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms 1

Acute Otitis Media

• For children with recent antibiotic use (within 4-6 weeks): 90 mg/kg/day (720 mg twice daily) to cover β-lactamase-producing organisms 1
• The high-dose formulation has demonstrated high eradication rates of penicillin-resistant S. pneumoniae 2

Group A Streptococcal Infections

• Recommended dose: 50-75 mg/kg/day divided into 2 doses (400-600 mg twice daily for this 16kg child) for 10 days 1

Practical Formulation Selection

Available Formulations

• Augmentin ES-600 suspension: Contains 600 mg amoxicillin/42.9 mg clavulanate per 5 mL, specifically designed for high-dose pediatric regimens 2, 3
• For 90 mg/kg/day dosing in a 16kg child (720 mg twice daily): Administer 6 mL twice daily of ES-600 suspension
• For 45 mg/kg/day dosing in a 16kg child (360 mg twice daily): Use standard formulations with appropriate volume calculations

Treatment Duration and Monitoring

Standard Duration

• Most respiratory infections: 7-10 days 1
• Pneumonia specifically: 10 days 1
• Group A Streptococcal infections: 10 days 1

Clinical Monitoring

• Children should demonstrate clinical improvement within 48-72 hours 1
• If no improvement occurs within this timeframe, reevaluation and further investigation are necessary 1
• Fever typically resolves within 24-48 hours for pneumococcal infections, though cough may persist longer 1

Safety Considerations

Common Adverse Effects

• The most common adverse effects include mild gastrointestinal disturbances such as diarrhea, nausea, and vomiting 1
• Diarrhea is generally less frequent with twice-daily dosing compared to three-times-daily regimens 2
• The high-dose formulation shows similar tolerability to conventional formulations 2, 3

Maximum Dose Limitation

• The maximum daily dose should not exceed 4000 mg/day of the amoxicillin component regardless of weight 1
• For this 16kg child, even the high-dose regimen (1440 mg/day) remains well below this maximum

Critical Pitfalls to Avoid

• Do not underdose severe infections: Always use 90 mg/kg/day for life-threatening infections, empyema, or documented resistant pneumococcus 1
• Do not use standard dosing for children with recent antibiotic exposure: These patients require high-dose regimens to cover resistant organisms 1
• Ensure complete course completion: Even if symptoms improve before completion, the full course must be administered 1