What is the recommended dose of Augmentin (amoxicillin/clavulanate) liquid formulation for a 17.8 kg female child?

Augmentin Dosing for 17.8 kg Female Child

For a 17.8 kg child, administer Augmentin 90 mg/kg/day of the amoxicillin component divided into 2 doses (approximately 800 mg twice daily or 8 mL of the 600 mg/5 mL suspension twice daily), which is the standard high-dose regimen recommended for most pediatric infections. 1, 2, 3

Weight-Based Calculation

• For this 17.8 kg child, the calculation is: 17.8 kg × 90 mg/kg/day = 1,602 mg/day total, divided into 2 doses = 801 mg per dose (approximately 800 mg twice daily) 3
• Using the high-dose suspension (600 mg/5 mL or ES-600 formulation), this equals approximately 6.7 mL per dose, rounded to 7-8 mL twice daily 1, 2
• The maximum daily dose should not exceed 4,000 mg/day of amoxicillin component regardless of weight 1, 3

Rationale for High-Dose Regimen

The 90 mg/kg/day regimen is the preferred standard for most pediatric infections because it provides adequate coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms like Haemophilus influenzae and Moraxella catarrhalis. 2, 3

• The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate (90 mg/kg amoxicillin with 6.4 mg/kg clavulanate), which achieves therapeutic concentrations while minimizing gastrointestinal side effects 2, 4
• This dosing is specifically indicated for children with risk factors including age <2 years, daycare attendance, recent antibiotic use within 30 days, incomplete *H. influenzae* type b vaccination, or geographic areas with >10% penicillin-resistant pneumococcal prevalence 2, 3

Indication-Specific Considerations

For Respiratory Tract Infections (Pneumonia, Sinusitis)

• Administer 90 mg/kg/day divided into 2 doses for 10 days 1, 3
• For community-acquired pneumonia in children <5 years, this high-dose regimen is first-line therapy 2, 3

For Acute Otitis Media

• Use 90 mg/kg/day divided into 2 doses for 10 days, particularly for severe AOM, bilateral AOM in children 6-23 months, or recent antibiotic exposure 2, 3

For Mild Infections Without Risk Factors

• A lower dose of 45 mg/kg/day divided into 2 doses may be considered (approximately 400 mg twice daily for this child), but the 90 mg/kg/day regimen is increasingly preferred as standard therapy 1, 3

Treatment Duration and Monitoring

• Standard treatment duration is 7-10 days for most infections; 10 days specifically for pneumonia and acute otitis media 1, 3
• Clinical improvement should be evident within 48-72 hours; if no improvement or worsening occurs, reevaluate the diagnosis and consider atypical pathogens or complications 1, 3

Common Pitfalls to Avoid

• Verify the suspension concentration before dispensing - the ES-600 formulation (600 mg/5 mL) is different from standard formulations (200 mg/5 mL or 400 mg/5 mL), and dosing errors are common 2
• Do not use subtherapeutic doses, as they fail to achieve adequate tissue concentrations and promote antimicrobial resistance 2
• The addition of clavulanate is essential for β-lactamase-producing organisms, with eradication rates approaching 100% when the combination is used appropriately 1

Adverse Effects

• Common adverse effects include diarrhea (occurs in approximately 25% vs 15% placebo) and gastrointestinal disturbances 1, 2
• The 14:1 ratio formulation causes less diarrhea than other amoxicillin-clavulanate preparations while maintaining efficacy 2