Augmentin DDS 540mg Per Dose: Twice-Daily Administration
For a 20-month-old child weighing 12 kg receiving Augmentin DDS at 540mg per dose, administer this dose twice daily (every 12 hours), which provides the guideline-recommended high-dose regimen of 90 mg/kg/day of amoxicillin. 1
Dosing Calculation and Rationale
The 540mg dose represents the amoxicillin component, and when given twice daily, delivers 1,080 mg/day total, which equals exactly 90 mg/kg/day for a 12 kg child (12 kg × 90 mg/kg/day = 1,080 mg/day). 1
Twice-daily dosing is the preferred administration schedule because it improves adherence and achieves superior pharmacokinetic profiles compared to three-times-daily regimens. 1, 2
The high-dose regimen of 90 mg/kg/day divided into 2 doses is specifically designed to provide optimal coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing Haemophilus influenzae, the most common resistant pathogens in pediatric respiratory infections. 1, 3
Practical Administration Schedule
Administer 540mg every 12 hours (e.g., 8 AM and 8 PM) to maintain consistent therapeutic levels throughout the day. 1
Treatment duration should continue for 7-10 days for most respiratory infections, with a minimum of 48-72 hours beyond symptom resolution. 1
Clinical improvement should be evident within 48-72 hours; if no improvement occurs, reevaluation for treatment failure or atypical pathogens is necessary. 1
Safety Considerations for This Dose
This dose remains well below the absolute maximum limit of 4,000 mg/day of amoxicillin, providing a safe margin even for this high-dose regimen. 3
The twice-daily formulation has demonstrated equivalent efficacy to three-times-daily dosing while showing a trend toward lower incidence of gastrointestinal adverse events, particularly diarrhea, due to the reduced daily clavulanate exposure. 4, 5
Critical Pitfall to Avoid
Do not split this dose into three times daily (e.g., 360mg three times daily), as this would reduce the per-dose concentration and compromise the pharmacodynamic profile needed to overcome resistant pathogens. 1, 6
Avoid underdosing in severe infections or when resistant pathogens are suspected, as the 90 mg/kg/day regimen is critical for adequate coverage. 1