What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 10-year-old patient weighing 67 pounds with normal renal function and no known allergies to penicillin or cephalosporins?

Augmentin Dosing for a 10-Year-Old Weighing 67 Pounds

For a 10-year-old child weighing 67 pounds (30.4 kg), the recommended dose of Augmentin is 1,370 mg of the amoxicillin component per day (685 mg twice daily) for standard infections, or 2,740 mg per day (1,370 mg twice daily) for severe infections or high-risk situations. 1

Weight-Based Calculation

• Patient weight: 67 pounds = 30.4 kg
• Standard dose calculation: 30.4 kg × 45 mg/kg/day = 1,368 mg/day, divided into 685 mg twice daily 1, 2
• High-dose calculation: 30.4 kg × 90 mg/kg/day = 2,736 mg/day, divided into 1,368 mg twice daily 1, 2

Indication-Based Dosing Algorithm

Use Standard Dose (45 mg/kg/day) When:

• The infection is mild to moderate in severity 1
• No antibiotic use in the past 4-6 weeks 1
• Child is ≥2 years old and not in daycare 1
• Geographic area has <10% penicillin-resistant S. pneumoniae 1

Use High Dose (90 mg/kg/day) When:

• Moderate to severe illness at presentation 1
• Child is <2 years old 1
• Recent antibiotic exposure within past 4-6 weeks 1
• Attending daycare 1
• Geographic area with >10% penicillin-resistant S. pneumoniae 1
• Treatment failure on standard-dose amoxicillin 1, 3

Practical Formulation Selection

• For standard dosing (685 mg twice daily): Use the 600 mg/5 mL suspension, giving approximately 5.7 mL twice daily, or use tablets if the child can swallow them 4
• For high-dose regimen (1,370 mg twice daily): Use the high-dose formulation (600 mg/5 mL) providing a 14:1 ratio of amoxicillin to clavulanate, giving approximately 11.4 mL twice daily 2, 5
• The high-dose formulation minimizes gastrointestinal side effects by maintaining the same clavulanate dose while doubling the amoxicillin component 2, 5

Treatment Duration

• Continue treatment for 10 days for most respiratory tract infections including pneumonia and acute bacterial sinusitis 1, 2
• Clinical improvement should occur within 48-72 hours; if no improvement or worsening occurs, reevaluation is necessary 1, 2
• For streptococcal pharyngitis, complete a full 10-day course to prevent acute rheumatic fever 4

Critical Pitfalls to Avoid

Underdosing in High-Risk Situations

• Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms 2
• Children with recent antibiotic exposure, daycare attendance, or age <2 years require the 90 mg/kg/day regimen 1

Incorrect Formulation Selection

• Do not use the 4:1 or 7:1 ratio formulations when high-dose therapy is needed 5
• The 14:1 ratio (ES-600 formulation) is specifically designed for high-dose regimens to minimize diarrhea 2, 5

Premature Discontinuation

• Complete the full course even if symptoms improve before completion 2
• For Streptococcus pyogenes infections, a minimum 10-day course is mandatory 4

Administration Instructions

• Administer at the start of meals to minimize gastrointestinal intolerance 4
• Shake oral suspension well before each use 4
• Refrigeration is preferable but not required; discard unused suspension after 14 days 4

Maximum Dose Considerations

• The maximum single dose should not exceed 2,000 mg of the amoxicillin component regardless of weight 2
• For this 30.4 kg patient, even the high-dose regimen (1,370 mg twice daily) remains well below the maximum 2