Augmentin (Amoxicillin-Clavulanate) Pediatric Dosing in mg/kg
The standard pediatric dose of Augmentin is 45 mg/kg/day of the amoxicillin component divided into 2-3 doses, but high-dose therapy at 90 mg/kg/day (with 6.4 mg/kg/day clavulanate) divided into 2 doses is strongly recommended for most respiratory infections and any child with risk factors for resistant organisms. 1
Standard vs. High-Dose Regimens
Standard Dose
- 45 mg/kg/day of amoxicillin component divided into 3 doses (15 mg/kg per dose) 1
- Used only for uncomplicated infections in low-risk children 1
- Maximum single dose: 2 grams regardless of weight 1
High-Dose Regimen (Preferred for Most Cases)
- 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day clavulanate divided into 2 doses (45 mg/kg per dose) 1, 2
- Provides a 14:1 ratio of amoxicillin to clavulanate 1
- Maximum daily dose: 4000 mg/day of amoxicillin component 1, 3
Indications for High-Dose Therapy (90 mg/kg/day)
Use high-dose therapy if ANY of the following risk factors are present: 1, 2
- Age <2 years 1
- Daycare attendance 1, 2
- Recent antibiotic use (within previous 30 days) 1, 2
- Incomplete Haemophilus influenzae type b vaccination (less than 3 injections) 1
- Geographic area with >10% penicillin-resistant S. pneumoniae 1, 2
- Moderate to severe illness 1
- Concurrent purulent otitis media 1
- Bilateral acute otitis media in children 6-23 months 1
Age-Based Dosing for Standard Infections
Oral Suspension Dosing
- <1 year (1-12 months): 2.5 ml of 125/31 suspension three times daily 1
- 1-6 years: 5 ml of 125/31 suspension three times daily 1
- 7-12 years: 5 ml of 250/62 suspension three times daily 1
- 12-18 years: 1 tablet (250/125) three times daily 1
Critical caveat: These age-based volumes apply only to standard-dose therapy for uncomplicated infections. For respiratory infections or any risk factors, calculate the high-dose regimen (90 mg/kg/day) based on actual weight. 1
Intravenous Dosing
- 30 mg/kg three times daily (every 8 hours) based on amoxicillin component, regardless of age 3
- Alternative: 100-200 mg/kg/day divided every 6-8 hours 3
- Maximum: 4000 mg/day of amoxicillin component 3
- Administer as IV infusion over 15-30 minutes 3
- Indicated for severe infections, inability to tolerate oral medications, or hospitalized patients 3
Specific Infection Types
Acute Otitis Media
- 90 mg/kg/day divided into 2 doses for 10 days 1
- High-dose regimen achieves 90-92% predicted clinical efficacy against penicillin-resistant S. pneumoniae 1
- Children <2 years specifically warrant high-dose formulation 1
Community-Acquired Pneumonia
- Outpatient children <5 years: 90 mg/kg/day in 2 doses 1
- Outpatient children ≥5 years: 90 mg/kg/day in 2 doses (maximum 4000 mg/day) 1
- Duration: 10 days 1
- For children <3 years without risk factors, consider amoxicillin alone at 80-100 mg/kg/day first 1
Acute Bacterial Rhinosinusitis
- 90 mg/kg/day divided into 2 doses for 10-14 days 1
- Strong recommendation for high-dose as first-line therapy 1
Treatment Duration
- Most respiratory infections: 10 days 1
- Acute bacterial rhinosinusitis: 10-14 days 1, 2
- Bacterial pneumonia: 10 days 1
- Continue for 7 days after patient becomes free of signs and symptoms 1
Clinical Monitoring
- Expect clinical improvement within 48-72 hours 1
- If no improvement or worsening after 72 hours: reevaluate diagnosis, consider atypical pathogens, evaluate for complications, or switch antibiotics 1
Common Pitfalls to Avoid
- Verify suspension concentration (125/31 vs 250/62) before calculating volume to avoid dosing errors 1
- Never use standard doses when high-dose therapy is indicated - this leads to treatment failure with resistant organisms and promotes antimicrobial resistance 1
- Do not underdose - subtherapeutic doses fail to achieve adequate tissue concentrations even against susceptible organisms 1
- Adjust dose in renal insufficiency - prolong dosing interval according to creatinine clearance to avoid accumulation 1