What is the recommended dose of Augmentin (amoxicillin/clavulanic acid) for a 14kg child with a moderate infection and no underlying renal impairment?

Augmentin Dosing for a 14 kg Child

For a 14 kg child with a moderate infection, administer Augmentin at 45 mg/kg/day of the amoxicillin component divided into two doses (approximately 315 mg twice daily), or for severe infections or high-resistance areas, use 90 mg/kg/day divided into two doses (approximately 630 mg twice daily). 1, 2

Standard Dosing Algorithm

Mild to Moderate Infections

• Standard dose: 45 mg/kg/day divided every 12 hours 1, 3
• For a 14 kg child: 45 mg/kg/day = 630 mg total daily dose
• This equals approximately 315 mg twice daily 1
• Using the 250 mg/5 mL suspension: approximately 6.3 mL twice daily 3

Severe Infections or High-Risk Situations

• High-dose regimen: 90 mg/kg/day divided every 12 hours 1, 2
• For a 14 kg child: 90 mg/kg/day = 1,260 mg total daily dose
• This equals approximately 630 mg twice daily 1, 2
• Using the high-dose formulation (600 mg/5 mL): approximately 5.3 mL twice daily 2

When to Use High-Dose Therapy

High-dose Augmentin (90 mg/kg/day) is indicated when any of the following risk factors are present: 2

• Age less than 2 years 2
• Daycare attendance 2
• Recent antibiotic use within the past 30 days 1, 2
• Incomplete Haemophilus influenzae type b vaccination (less than 3 injections) 2
• Geographic area with high prevalence of penicillin-resistant S. pneumoniae (>10%) 1, 2
• Moderate to severe illness 2
• Concurrent purulent acute otitis media 1

Indication-Specific Considerations

Community-Acquired Pneumonia

• Outpatient children under 5 years: 90 mg/kg/day in 2 doses 2
• Treatment duration: 10 days 1, 2
• The high-dose formulation provides adequate coverage for β-lactamase-producing H. influenzae and penicillin-resistant S. pneumoniae 1, 2

Acute Otitis Media

• High-dose regimen (90 mg/kg/day) for 10 days is recommended for severe AOM, bilateral AOM in children 6-23 months, or recent antibiotic exposure 2
• This achieves middle ear fluid concentrations adequate to overcome penicillin-resistant S. pneumoniae 2

Acute Bacterial Rhinosinusitis

• High-dose amoxicillin-clavulanate (90 mg/kg/day divided BID) is first-line therapy 2
• Treatment duration: 10-14 days 2

Critical Dosing Considerations

Formulation Selection

• The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate (90 mg/kg amoxicillin with 6.4 mg/kg clavulanate) 2
• This ratio causes less diarrhea than other amoxicillin-clavulanate preparations while maintaining efficacy 2
• Always verify the suspension concentration before calculating volume to avoid dosing errors 2

Maximum Dose

• Maximum daily dose: 4000 mg/day of amoxicillin component regardless of weight 1
• Maximum single dose: 2000 mg per dose 2

Treatment Duration

• Continue treatment for a minimum of 48-72 hours beyond symptom resolution 3
• For most respiratory infections: 7-10 days 1
• For pneumonia specifically: 10 days 1, 2
• For Streptococcus pyogenes infections: minimum 10 days to prevent acute rheumatic fever 3

Administration Guidelines

• Administer at the start of a meal to minimize gastrointestinal intolerance 3
• After reconstitution, place suspension directly on the child's tongue or mix with formula, milk, fruit juice, water, or cold drinks and administer immediately 3
• Shake oral suspension well before each use 3
• Refrigeration is preferable but not required 3
• Discard unused suspension after 14 days 3

Monitoring and Follow-Up

• Clinical improvement should be evident within 48-72 hours of starting therapy 1, 2
• If no improvement or worsening occurs after 72 hours, reevaluate the diagnosis and consider switching antibiotics or investigating for complications 1, 2
• Fever typically resolves within 24-48 hours for pneumococcal infections, though cough may persist longer 1

Common Pitfalls to Avoid

• Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms 2
• Subtherapeutic doses fail to achieve adequate serum and tissue concentrations and promote antimicrobial resistance 2
• Most upper respiratory tract infections are viral and do not require antibiotics at all 2
• Ensure the child meets criteria for bacterial infection before prescribing 2

Adverse Effects

• Most common: gastrointestinal disturbances (diarrhea, nausea, vomiting) 1, 2
• Diarrhea is generally less frequent with twice-daily dosing compared to three-times-daily dosing 4
• Rash, urticaria, and other hypersensitivity reactions may occur 1
• The high-dose formulation shows similar tolerability to conventional formulations 4