What is the recommended oral dose of Augmentin (amoxicillin/clavulanate) for a 38kg child with normal renal function and no known allergies to penicillin or clavulanate?

Augmentin Dosing for a 38kg Child

Standard Dosing Recommendation

For a 38kg child with normal renal function, the standard dose of Augmentin is 45 mg/kg/day of the amoxicillin component divided into two doses (approximately 855 mg twice daily), or 90 mg/kg/day divided into two doses (approximately 1,710 mg twice daily) for severe infections or areas with high pneumococcal resistance. 1, 2

Weight-Based Calculation

• For standard dosing: 38 kg × 45 mg/kg/day = 1,710 mg/day total, divided into 855 mg twice daily 1
• For high-dose regimen: 38 kg × 90 mg/kg/day = 3,420 mg/day total, divided into 1,710 mg twice daily 1, 3
• The maximum single dose should not exceed 2,000 mg regardless of weight 1, 2

Indication-Specific Algorithm

For Mild to Moderate Respiratory Infections

• Use 45 mg/kg/day divided into two doses (855 mg twice daily for this 38kg child) 1, 2
• This provides adequate coverage for most susceptible pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2, 4

For Severe Infections or High-Risk Situations

• Use 90 mg/kg/day divided into two doses (1,710 mg twice daily for this 38kg child) when: 1, 3
  • Geographic area has >10% penicillin-resistant S. pneumoniae 1
  • Recent antibiotic exposure within the past 30 days 3
  • Daycare attendance 3
  • Age <2 years 3
  • Severe or complicated infection 1

Practical Formulation Considerations

• Since this child weighs <40 kg, use pediatric weight-based dosing rather than adult tablet formulations 5
• The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which minimizes gastrointestinal side effects while maintaining efficacy 1, 3
• For the standard dose (855 mg twice daily), this can be administered as approximately 8.5 mL of the 400 mg/57 mg per 5 mL suspension twice daily 5
• For the high-dose regimen (1,710 mg twice daily), this can be administered as approximately 14 mL of the 600 mg/42.9 mg per 5 mL suspension (ES-600 formulation) twice daily 1, 6

Treatment Duration and Monitoring

• Continue treatment for 10 days for most respiratory infections, including pneumonia and acute bacterial sinusitis 1, 2
• Clinical improvement should be evident within 48-72 hours; if no improvement or worsening occurs, reevaluation is necessary 1, 3
• Administer at the start of meals to minimize gastrointestinal intolerance and enhance clavulanate absorption 5, 7

Common Pitfalls to Avoid

Critical Dosing Errors

• Underdosing is a critical error: Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms 1
• Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amounts of clavulanic acid 5
• Verify the suspension concentration before calculating volume to avoid dosing errors 3

Inappropriate Antibiotic Use

• Most upper respiratory tract infections are viral and do not require antibiotics at all 1
• Ensure the indication truly warrants antibacterial therapy before prescribing 1, 7

Formulation Confusion

• The 250 mg/125 mg tablet and the 250 mg/62.5 mg chewable tablet are not interchangeable 5
• Different formulations have different amoxicillin:clavulanate ratios, which affects both efficacy and tolerability 3, 6