What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 41 kg pediatric patient?

Augmentin Dosing for a 41 kg Patient

For a 41 kg patient, the recommended Augmentin dose is 875 mg every 12 hours or 500 mg every 8 hours for standard infections, or 90 mg/kg/day (approximately 1845 mg/day divided into two doses of 920 mg each) for high-dose therapy when treating resistant organisms or severe infections. 1

Weight-Based Dosing Threshold

Since this patient weighs 41 kg (just over the 40 kg threshold), they should be dosed as an adult rather than using pediatric weight-based calculations 2, 3. However, the specific clinical context determines whether standard adult dosing or high-dose therapy is appropriate.

Standard Adult Dosing Regimens

For most mild to moderate infections in patients ≥40 kg:

• 500 mg every 12 hours or 250 mg every 8 hours for mild infections 3
• 875 mg every 12 hours or 500 mg every 8 hours for moderate to severe infections 3
• Treatment duration is typically 7-10 days, with continuation for 48-72 hours after symptom resolution 3

High-Dose Regimen Indications

High-dose therapy (90 mg/kg/day) should be used when any of the following risk factors are present:

• Recent antibiotic use within the previous 30 days 1, 4
• Daycare attendance or close contact with children in daycare 1, 4
• Geographic area with high prevalence (>10%) of penicillin-resistant Streptococcus pneumoniae 1, 4
• Moderate to severe illness 1, 4
• Age under 2 years (though this patient is older) 1
• Treatment failure with standard-dose amoxicillin 1
• Incomplete Haemophilus influenzae type b vaccination 1

For a 41 kg patient requiring high-dose therapy: 90 mg/kg/day = 3690 mg/day, divided into two doses of 1845 mg every 12 hours 1. In practice, this would be approximated as two 875 mg tablets (1750 mg) twice daily or 2000 mg twice daily using the extended-release formulation 4, 5.

Infection-Specific Dosing

Respiratory Tract Infections

• Standard therapy: 875 mg every 12 hours for 7-10 days 4, 3
• High-dose therapy (with risk factors): 2000 mg/125 mg twice daily 4, 5

Acute Bacterial Sinusitis

• Standard: 500 mg/125 mg three times daily or 875 mg/125 mg twice daily for 5-7 days 4
• With risk factors: 2000 mg/125 mg twice daily 4

Skin/Soft Tissue Infections

• Mild/moderate: 500 mg every 12 hours 3
• Severe: 875 mg every 12 hours 3

Animal/Human Bites

• 875 mg/125 mg twice daily 4

Critical Dosing Considerations

Common pitfalls to avoid:

• Do not use the 875 mg dose if the patient has severe renal impairment (GFR <30 mL/min) 3
• Verify that you're using adult dosing for patients ≥40 kg, not pediatric weight-based calculations 2, 3
• When high-dose therapy is indicated, using standard doses leads to treatment failure rates of 20-25% with resistant organisms 4
• Always administer at the start of a meal to minimize gastrointestinal intolerance 3

Renal Dose Adjustment

For patients with renal impairment:

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours (do NOT use 875 mg dose) 3
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3
• Hemodialysis: 500 mg or 250 mg every 24 hours, with additional dose during and after dialysis 3

Treatment Monitoring

• Expect clinical improvement within 48-72 hours 1, 4
• If no improvement or worsening after 72 hours, reevaluate diagnosis, consider resistant pathogens, or switch antibiotics 1, 4
• Continue treatment for minimum 48-72 hours after symptom resolution 3
• For Streptococcus pyogenes infections, treat for at least 10 days to prevent acute rheumatic fever 3