What is the appropriate Augmentin (amoxicillin/clavulanic acid) preparation for a 4-year-old child weighing 16kg?

Augmentin Preparation for a 16kg, 4-Year-Old Child

For a 4-year-old child weighing 16kg, prescribe Augmentin oral suspension 90 mg/kg/day of the amoxicillin component, divided into 2 doses (720 mg twice daily), using the high-dose formulation (600 mg/5 mL) to provide 6 mL twice daily. 1

Weight-Based Dosing Calculation

• Standard dose calculation: 16 kg × 90 mg/kg/day = 1,440 mg/day total, divided into 720 mg per dose twice daily 1, 2
• The high-dose formulation (Augmentin ES-600: 600 mg amoxicillin/42.9 mg clavulanate per 5 mL) provides the optimal 14:1 ratio needed for resistant organisms 3
• Practical administration: Give 6 mL of the 600 mg/5 mL suspension every 12 hours 1

Rationale for High-Dose Regimen

• The 90 mg/kg/day dosing is preferred over 45 mg/kg/day for most pediatric infections because it provides adequate coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 1, 4
• High-dose amoxicillin/clavulanate achieves superior bacteriologic eradication rates (approaching 100%) against β-lactamase-producing organisms compared to standard dosing 1
• For community-acquired pneumonia specifically, the Infectious Diseases Society of America recommends 90 mg/kg/day in 2 doses as first-line therapy 5, 2

Formulation Selection

• Use the high-dose suspension (600 mg/5 mL) rather than standard formulations (200 mg/5 mL or 400 mg/5 mL) to minimize clavulanate exposure and reduce gastrointestinal side effects 3
• The 14:1 ratio formulation provides double the amoxicillin while maintaining the same clavulanate dose as conventional preparations, improving tolerability 3
• Avoid using tablets: The 250 mg/125 mg tablets should not be used until the child weighs at least 40 kg 6

Administration Guidelines

• Give at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance 6
• Twice-daily dosing improves adherence and reduces diarrhea compared to three-times-daily regimens 7, 3
• Complete the full course (typically 7-10 days for respiratory infections, 10 days for pneumonia) even if symptoms improve 1

Monitoring and Follow-Up

• Expect clinical improvement within 48-72 hours; if no improvement occurs, reevaluation and consideration of alternative pathogens or resistant organisms is necessary 1, 4
• Fever should resolve within 24-48 hours for typical bacterial infections, though cough may persist longer 1
• If the patient deteriorates or shows no improvement by 48-72 hours, consider adding coverage for atypical pathogens with a macrolide 1

Critical Considerations

• Maximum daily dose: Do not exceed 4,000 mg/day of the amoxicillin component regardless of weight 1, 2
• For β-lactam allergic patients with non-anaphylactic reactions, consider cephalosporins (cefdinir, cefuroxime); for Type I hypersensitivity, use azithromycin or levofloxacin 1
• The addition of clavulanate is essential for infections caused by β-lactamase-producing organisms, with eradication rates approaching 100% when properly dosed 1