What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 38kg child?

Augmentin Dosing for a 38kg Child

For a 38kg child, the recommended dose of Augmentin is 90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate, divided into 2 doses, which equals 1710 mg of amoxicillin twice daily (maximum 2000 mg per dose), or practically 1500-1750 mg twice daily depending on available formulations. 1

Weight-Based Calculation

• For a 38kg child, the high-dose regimen calculation is: 38 kg × 90 mg/kg/day = 3420 mg/day total, divided into 2 doses = 1710 mg per dose 1
• The American Academy of Pediatrics recommends a maximum single dose of 2000 mg per dose regardless of weight, so this child is below the maximum threshold 1
• This provides the 14:1 ratio of amoxicillin to clavulanate (90 mg/kg amoxicillin with 6.4 mg/kg clavulanate) that is the preferred high-dose regimen for most pediatric infections 1

Practical Formulation Selection

• For children weighing >40 kg, use adult dosing: one 875 mg tablet twice daily or 2000 mg twice daily for severe infections 1
• Since this child weighs 38 kg (just under 40 kg), you can either:
  • Use two 875 mg tablets twice daily (1750 mg per dose) - slightly above calculated dose but within safe range 1
  • Use suspension if available: approximately 35 mL of the 600 mg/42.9 mL (ES-600) formulation twice daily 2, 3

Indications for High-Dose Therapy

The high-dose regimen (90 mg/kg/day) is indicated for children with specific risk factors: 1

• Age <2 years
• Daycare attendance
• Recent antibiotic use within the previous 30 days
• Incomplete Haemophilus influenzae type b vaccination
• Geographic area with high prevalence of penicillin-resistant Streptococcus pneumoniae (>10%)
• Moderate to severe illness
• Concurrent purulent acute otitis media

Treatment Duration and Monitoring

• The standard treatment duration is 10 days for most respiratory and soft tissue infections 1
• Clinical improvement should be evident within 48-72 hours of starting therapy 1
• If no improvement or worsening occurs after 72 hours, reassess the diagnosis and consider alternative pathogens or complications 1

Common Pitfalls to Avoid

• Underdosing is a critical error - using standard doses (45 mg/kg/day) when high-dose therapy is indicated leads to treatment failure with resistant organisms 1
• The high-dose formulation (14:1 ratio) causes less diarrhea than the older 7:1 formulations while maintaining superior efficacy 1, 4
• Always verify the suspension concentration before calculating volume to avoid dosing errors 1

Renal Adjustment

• In patients with renal insufficiency, prolonging the dosing interval according to creatinine clearance is essential to avoid accumulation 1
• For children with altered renal function, the dose should be significantly reduced due to renal elimination of both components 1