What is the appropriate dosage of amoxicillin (amoxicillin) and potassium clavulanate (clavulanate) 220/28.5 mg and paracetamol (acetaminophen) 125/5 ml for a 20-month-old pediatric patient?

Dosage Recommendations for Amoxicillin-Clavulanate and Paracetamol in a 20-Month-Old Child

For a 20-month-old child, the recommended dose of amoxicillin-clavulanate is 90 mg/kg/day of the amoxicillin component divided into 2 doses (high-dose regimen), which provides optimal coverage against resistant respiratory pathogens common in this age group. 1

Amoxicillin-Clavulanate Dosing

High-Dose Regimen (Preferred for Children <2 Years)

• Children under 2 years of age should receive the high-dose regimen of 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate divided into 2 doses, as this age group is at increased risk for infections with resistant organisms. 1

• The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which causes less diarrhea than other preparations while maintaining superior efficacy against penicillin-resistant Streptococcus pneumoniae. 1

Practical Dosing Calculation

To calculate the exact dose for your 20-month-old patient:

• First, determine the child's weight (essential for accurate dosing). 1

• Calculate: Weight (kg) × 90 mg = total daily amoxicillin dose, then divide by 2 for each dose. 1

• For example, if the child weighs 12 kg: 12 kg × 90 mg = 1,080 mg daily, or 540 mg per dose twice daily. 1

Formulation Selection

• For children aged 1-6 years, use 5 ml of 125/31 suspension three times daily if using the standard formulation, though the twice-daily high-dose regimen is preferred. 1

• The 220/28.5 mg formulation you mentioned appears to be a specific suspension concentration—verify the exact concentration per ml to calculate the appropriate volume. 2

• The high-dose suspension (typically 600 mg/5 ml formulations) allows for twice-daily dosing, which improves compliance and reduces gastrointestinal side effects. 1, 3

Critical Risk Factors Present at 20 Months

Your patient has multiple indications for high-dose therapy:

• Age <2 years is itself a risk factor requiring high-dose amoxicillin-clavulanate (90 mg/kg/day). 1

• If the child attends daycare, has had recent antibiotic use (within 30 days), or has incomplete Haemophilus influenzae type b vaccination, high-dose therapy is mandatory. 1

• Geographic areas with >10% prevalence of penicillin-resistant S. pneumoniae also require high-dose therapy. 1

Treatment Duration

• Continue treatment for 10 days for most respiratory infections including acute otitis media, sinusitis, and pneumonia. 1

• Expect clinical improvement within 48-72 hours; if no improvement or worsening occurs, reevaluate the diagnosis and consider alternative pathogens or complications. 1

Administration Guidelines

• Administer at the start of meals to minimize gastrointestinal intolerance and enhance clavulanate absorption. 2

• Shake the oral suspension well before each use. 2

• Store reconstituted suspension under refrigeration and discard after 10 days. 2

Paracetamol (Acetaminophen) Dosing

Standard Pediatric Dosing

• For a 20-month-old child, administer paracetamol at 10-15 mg/kg per dose every 4-6 hours as needed, with a maximum of 5 doses in 24 hours. [General Medicine Knowledge]

• Using the 125 mg/5 ml suspension: Calculate the dose based on weight. For example, if the child weighs 12 kg: 12 kg × 15 mg = 180 mg per dose = 7.2 ml of the 125 mg/5 ml suspension. [General Medicine Knowledge]

• Maximum daily dose should not exceed 75 mg/kg/day or 4,000 mg/day (whichever is lower). [General Medicine Knowledge]

Practical Administration

• Measure doses accurately using an oral syringe or dosing cup provided with the medication. [General Medicine Knowledge]

• Space doses at least 4 hours apart to avoid overdosing. [General Medicine Knowledge]

• Use for fever >38.5°C (101.3°F) or for pain relief as needed, not routinely around-the-clock unless specifically indicated. [General Medicine Knowledge]

Common Pitfalls to Avoid

• Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amounts of clavulanate and are not equivalent. 2

• Do not use standard-dose amoxicillin-clavulanate (45 mg/kg/day) in children <2 years when high-dose therapy is indicated, as this leads to treatment failure with resistant organisms. 1

• Verify the suspension concentration before calculating volume—different formulations (125/31,200/28.5,250/62,400/57 mg per 5 ml) require different volumes to achieve the same dose. 1

• The 220/28.5 mg formulation requires careful calculation—determine if this represents the concentration per ml or per dose unit to avoid dosing errors. 2