Augmentin Dosing for a 25kg Child
For a 25kg child with a moderate to severe infection, administer Augmentin 90 mg/kg/day of the amoxicillin component divided into 2 doses, which equals 1,125 mg twice daily (approximately 11-12 mL of the 600mg/5mL suspension twice daily). 1, 2
Weight-Based Calculation
- For this 25kg child, the high-dose regimen calculation is: 25 kg × 90 mg/kg/day = 2,250 mg total daily dose of amoxicillin component 1
- This is divided into 2 doses: 1,125 mg per dose, given every 12 hours 1, 2
- Using the 600mg/5mL (ES-600) suspension: approximately 9.4 mL per dose (round to 9-10 mL for practical administration) 2
- Alternatively, using the 400mg/5mL suspension: approximately 14 mL per dose 2
When to Use High-Dose vs Standard-Dose Regimen
High-dose regimen (90 mg/kg/day in 2 doses) is indicated for: 1, 2
- Community-acquired pneumonia or lower respiratory tract infections
- Acute otitis media with risk factors (age <2 years, daycare attendance, recent antibiotic use within 30 days)
- Acute bacterial sinusitis in high-resistance areas
- Incomplete Haemophilus influenzae type b vaccination
- Geographic areas with >10% penicillin-resistant Streptococcus pneumoniae
- Moderate to severe infections requiring hospitalization
Standard-dose regimen (45 mg/kg/day in 2-3 doses) may be used for: 1
- Mild, uncomplicated infections without risk factors
- Skin and soft tissue infections
- Uncomplicated urinary tract infections
Treatment Duration and Monitoring
- Continue treatment for 10 days for most respiratory infections, including pneumonia 1, 2
- For acute otitis media, treat for 10 days 2
- Clinical improvement should be evident within 48-72 hours; if no improvement occurs, reevaluation is necessary 1, 2
- Complete the full course even if symptoms improve before completion 1
Critical Dosing Considerations
- The maximum daily dose should not exceed 4,000 mg/day of the amoxicillin component regardless of weight 1
- The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate (90 mg/6.4 mg per kg per day), which minimizes gastrointestinal side effects while maintaining efficacy 2
- This dosing achieves middle ear fluid and tissue concentrations adequate to overcome penicillin-resistant S. pneumoniae (MIC up to 2-4 mg/L) and β-lactamase-producing organisms 2, 3
Common Pitfalls to Avoid
- Do not use standard-dose formulations when high-dose therapy is indicated, as this leads to treatment failure with resistant organisms 2
- Verify the suspension concentration before dispensing (125/31,250/62, or 600/42.9 mg per 5mL) to avoid dosing errors 2
- Shake the suspension well before each use and refrigerate after reconstitution (though not required) 4
- Discard any unused suspension after 14 days of reconstitution 4
Administration Tips
- Administer at the start of a meal to minimize gastrointestinal intolerance 4
- The suspension can be placed directly on the child's tongue or mixed with formula, milk, fruit juice, or water, but must be taken immediately after mixing 4
- Common adverse effects include diarrhea (occurs in approximately 25% vs 15% placebo) and diaper dermatitis, but these are generally mild 2