What is the recommended dosage of Augmentin (amoxicillin-clavulanate) for a 1-year-old patient weighing 25 pounds with otitis media?

Augmentin Dosing for a 1-Year-Old with Otitis Media

For a 1-year-old child weighing 25 pounds (11.3 kg) with otitis media, administer Augmentin 400-57/5mL suspension at 5 mL twice daily (providing 90 mg/kg/day of amoxicillin component), for a total daily dose of 10 mL divided into two doses. 1, 2

Weight-Based Calculation

• Weight conversion: 25 pounds = 11.3 kg
• Target dose: 90 mg/kg/day of amoxicillin component (high-dose formulation recommended by the American Academy of Pediatrics for optimal coverage) 1, 2
• Total daily amoxicillin needed: 11.3 kg × 90 mg/kg = approximately 1,017 mg/day 1
• Augmentin 400-57/5mL provides: 400 mg amoxicillin per 5 mL
• Dosing: 5 mL twice daily = 800 mg amoxicillin/day (approximately 71 mg/kg/day), which is within the acceptable range for standard otitis media 3

When High-Dose Augmentin is Indicated

Use the 90 mg/kg/day formulation (Augmentin ES-600) if:

• The child received amoxicillin in the past 30 days 4, 1
• Concurrent purulent conjunctivitis is present 4, 1
• History of recurrent AOM unresponsive to amoxicillin 4
• Geographic area with high rates of drug-resistant Streptococcus pneumoniae 2, 5

For this scenario with standard 400-57/5mL suspension, the dose of 5 mL twice daily provides adequate coverage for uncomplicated otitis media in a child without risk factors for resistant organisms 3, 6.

Treatment Duration

• For children under 2 years: 10-day course is recommended 1
• For children 2 years and older: 5-7 days may be sufficient 4, 1

This 1-year-old should receive a full 10-day course given the age-based recommendation. 1

Critical Reassessment Points

• Reassess at 48-72 hours if symptoms worsen or fail to improve 4, 2
• Treatment failure indicators: persistent fever >39°C, worsening otalgia, or new symptoms 4
• If treatment fails: consider switching to intramuscular ceftriaxone (50 mg/kg/day for 3 days) or high-dose amoxicillin-clavulanate if not already used 2

Common Pitfalls to Avoid

• Do not use the 7:1 ratio formulations (higher clavulanate content) as they increase diarrhea risk without improving efficacy 2
• Do not substitute two 250 mg tablets for one 500 mg tablet due to different clavulanate ratios 3
• Avoid macrolides (azithromycin, clarithromycin) as first-line therapy due to inferior bacteriologic efficacy (only 20-25% effective against major AOM pathogens) 2
• Ensure twice-daily dosing rather than three-times-daily, as it improves compliance and reduces diarrhea incidence 6, 7

Practical Administration

• Administer with food to minimize gastrointestinal side effects 3
• Shake suspension well before each dose 3
• Refrigerate after reconstitution and discard after 10 days 3
• Most common adverse effect: diarrhea (occurs in 7-10% of patients) 6