Augmentin ES-600 Dosing for a 2-Year-Old with Acute Otitis Media
For this 11.4 kg, 2-year-old child with acute otitis media, prescribe Augmentin ES-600 at 513 mg twice daily (approximately 5.7 mL of the 600 mg/42.9 mg per 5 mL suspension twice daily) for 10 days. 1
Dose Calculation
The recommended high-dose regimen is 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate, divided into 2 doses. 1, 2
For an 11.4 kg child:
- Total daily amoxicillin dose: 90 mg/kg/day × 11.4 kg = 1,026 mg/day 1
- Divided into 2 doses: 513 mg twice daily (every 12 hours) 1
- Using Augmentin ES-600 suspension (600 mg/5 mL): approximately 5.7 mL twice daily 1
Why High-Dose Therapy is Indicated
This child meets multiple criteria requiring high-dose amoxicillin-clavulanate: 1
- Age under 2 years - Children below 2 years with AOM require antibiotic therapy and specifically warrant high-dose formulation 3, 1
- The high-dose 14:1 ratio formulation (90/6.4 mg/kg/day) achieves middle ear fluid concentrations adequate to overcome penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 1, 4
Treatment Duration and Monitoring
Prescribe for 10 days duration. 1, 2 Treatment duration is 8-10 days for children below 2 years of age 3, with most guidelines recommending the full 10-day course 1, 2.
Reassess the child if symptoms worsen or fail to improve within 48-72 hours. 1, 2 Clinical improvement should be evident within this timeframe 1. If treatment fails, consider switching antibiotics or further evaluation 3, 1.
Clinical Efficacy Evidence
The high-dose formulation (90/6.4 mg/kg/day) eradicated penicillin-resistant S. pneumoniae with MICs of 2-4 mg/L in clinical trials, with clinical response rates of 76-95%. 1 In comparative studies, amoxicillin-clavulanate at this dose demonstrated superior bacteriologic efficacy, eradicating 96% of S. pneumoniae (including 92% of fully penicillin-resistant strains) and 89.7% of H. influenzae 5.
Clinical success rates at end of therapy were 90.5% with high-dose amoxicillin-clavulanate versus 80.9% with azithromycin (P < 0.01). 5
Administration and Tolerability
Administer without regard to meals, though giving with meals may improve gastrointestinal tolerability. 2 The 14:1 ratio formulation causes less diarrhea than other amoxicillin-clavulanate preparations while maintaining efficacy 1. Common adverse effects include diarrhea (25% vs 15% placebo) and diaper dermatitis (51% vs 35% placebo) 3.
Critical Pitfalls to Avoid
Never use standard-dose amoxicillin-clavulanate (45 mg/kg/day) for children under 2 years with AOM. 1, 2 Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms 1. Subtherapeutic doses fail to achieve adequate tissue concentrations and promote antimicrobial resistance 1.
Verify you are prescribing Augmentin ES-600 specifically - this is the formulation designed to provide the 14:1 ratio (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) 1, 4. Other formulations will not achieve the appropriate dosing ratio.