Augmentin Dosing for School-Age Children
For school-age children (typically 5-12 years old), the recommended dose of Augmentin is 90 mg/kg/day of the amoxicillin component divided into 2 doses (given every 12 hours) for most respiratory tract infections, with a maximum daily dose of 4000 mg. 1, 2
Standard Dosing Algorithm
Weight-Based Calculation
- For children weighing less than 40 kg: Use 90 mg/kg/day of amoxicillin component divided into 2 doses 1, 2
- For children weighing 40 kg or more: Use adult dosing of 875 mg every 12 hours 3
- Maximum daily dose: 4000 mg of amoxicillin component regardless of weight 1
Age-Based Oral Suspension Dosing (Alternative Approach)
- Ages 7-12 years: 5 mL of 250/62 suspension three times daily 2
- Ages 1-6 years: 5 mL of 125/31 suspension three times daily 2
High-Dose Regimen Indications
The 90 mg/kg/day regimen is specifically indicated when any of these risk factors are present: 1, 2
- Age less than 2 years
- Daycare attendance
- Recent antibiotic use within the past 30 days
- Incomplete Haemophilus influenzae type b vaccination (less than 3 injections)
- Geographic area with high prevalence (>10%) of penicillin-resistant Streptococcus pneumoniae
- Moderate to severe illness
- Concurrent purulent acute otitis media
Indication-Specific Dosing
Community-Acquired Pneumonia
- Outpatient children <5 years: 90 mg/kg/day in 2 doses 2
- Outpatient children ≥5 years: 90 mg/kg/day in 2 doses 1, 2
- Treatment duration: 10 days 1, 2
Acute Otitis Media
- High-dose regimen: 90 mg/kg/day divided into 2 doses for 10 days 2
- Indicated for: Severe AOM, bilateral AOM in children 6-23 months, or recent amoxicillin use 2
Acute Bacterial Rhinosinusitis
Critical Formulation Considerations
The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate (90 mg/kg amoxicillin with 6.4 mg/kg clavulanate), which minimizes gastrointestinal side effects while maintaining efficacy. 2, 4
Available Formulations
- High-dose suspension: 600 mg amoxicillin/5 mL (Augmentin ES-600) 4
- Standard suspensions: 250/62 mg per 5 mL or 125/31 mg per 5 mL 2
- Tablets: For children ≥40 kg, 875/125 mg tablets 3
Treatment Duration and Monitoring
Expected Clinical Response
- Clinical improvement should occur within 48-72 hours of starting therapy 1, 2
- If no improvement or worsening after 72 hours: Reassess diagnosis, consider atypical pathogens, evaluate for complications, or switch antibiotics 1, 2
Standard Treatment Durations
- Most respiratory infections: 7-10 days 1
- Pneumonia: 10 days 1, 2
- Acute otitis media: 10 days 2
- Streptococcal infections: Minimum 10 days to prevent rheumatic fever 3
Common Pitfalls to Avoid
Dosing Errors
- Always verify suspension concentration (125/31 vs 250/62 vs 600/42.9) before calculating volume 2
- Do not use 875 mg tablets in children with renal impairment (GFR <30 mL/min) 3
- Subtherapeutic dosing (e.g., using 45 mg/kg/day when 90 mg/kg/day is indicated) leads to treatment failure and promotes resistance 2
Clinical Considerations
- Most upper respiratory tract infections are viral and do not require antibiotics 2
- Before prescribing, ensure criteria for bacterial infection are met (persistent symptoms >10 days, severe symptoms, or "double sickening") 2
- Administer at the start of meals to minimize gastrointestinal intolerance 3
Renal Impairment Adjustments
For children ≥3 months and >40 kg with severe renal impairment: 3
- GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours
- GFR <10 mL/min: 500 mg or 250 mg every 24 hours
- Hemodialysis: 500 mg or 250 mg every 24 hours, with additional dose during and after dialysis
Practical Example for School-Age Child
For a typical 7-year-old weighing 24 kg with community-acquired pneumonia: