What is the recommended dose of Augmentin (amoxicillin-clavulanate) for a 10kg infant with a severe infection and potentially impaired renal function?

Augmentin Dosing for a 10kg Infant with Severe Infection and Renal Impairment

For a 10kg infant with severe infection and potentially impaired renal function, administer Augmentin (ampicillin-sulbactam) at 200 mg/kg/day of the ampicillin component divided every 6 hours (500 mg every 6 hours), with dose adjustment based on creatinine clearance if renal impairment is confirmed. 1

Standard Dosing for Severe Pediatric Infections

• For complicated intra-abdominal infections and severe infections in children, the recommended dose is 200 mg/kg/day of the ampicillin component, divided every 6 hours. 1

• For a 10kg infant, this calculates to:

  • 200 mg/kg × 10kg = 2000 mg/day
  • Divided every 6 hours = 500 mg per dose 1

• The dosing range for ampicillin-sulbactam in pediatric complicated infections is 200-300 mg/kg/day, with higher doses reserved for more severe infections or when undrained abscesses may be present. 1, 2

Renal Function Considerations

• Dose adjustment is mandatory if renal impairment is confirmed, as β-lactam antibiotics require modification based on creatinine clearance. 1

• For patients with creatinine clearance 10-30 mL/min, standard pediatric dosing recommendations suggest reducing frequency or total daily dose, though specific pediatric renal dosing for ampicillin-sulbactam is not well-established in the guidelines provided. 1

• Monitor renal function closely and adjust dosing empirically based on clinical response and drug accumulation risk in the setting of impaired clearance. 1

Alternative Augmentin Formulations (Amoxicillin-Clavulanate)

If the question refers to amoxicillin-clavulanate rather than ampicillin-sulbactam:

• For severe infections in pediatric patients, high-dose amoxicillin-clavulanate at 90 mg/kg/day of the amoxicillin component divided into 2 doses is recommended. 3, 4, 5, 6

• For a 10kg infant:

  • 90 mg/kg × 10kg = 900 mg/day of amoxicillin
  • Divided into 2 doses = 450 mg every 12 hours 3, 6

• The standard dosing range for amoxicillin-clavulanate in children is 20-40 mg/kg/day for mild infections and up to 90 mg/kg/day for severe or resistant infections. 3, 4

Critical Monitoring Parameters

• Antibiotic serum concentrations and renal function should be monitored when using β-lactam antibiotics in patients with renal impairment. 1

• β-lactam antibiotic dosages should be maximized if undrained intra-abdominal abscesses may be present, as tissue penetration may be suboptimal. 1

• For severe infections requiring IV therapy, transition to oral therapy can occur once clinical improvement is documented, typically within 24-48 hours. 3

Common Pitfalls to Avoid

• Do not use standard adult renal dosing adjustments directly in pediatric patients—pediatric pharmacokinetics differ significantly, particularly in infants. 1

• Avoid underdosing in severe infections; the upper end of the dosing range (300 mg/kg/day for ampicillin-sulbactam or 90 mg/kg/day for amoxicillin-clavulanate) is appropriate for life-threatening infections. 1, 2, 4

• Ensure adequate hydration and monitor for signs of drug accumulation (neurological symptoms, rash) in the setting of renal impairment. 1