Maximum Augmentin Dose for a 5-Year-Old with Ear Infection
For a 5-year-old child weighing 101 pounds (45.9 kg) with an ear infection, the maximum dose is 4,000 mg per day of the amoxicillin component, administered as 2,000 mg twice daily (every 12 hours), which represents the high-dose regimen of 90 mg/kg/day with 6.4 mg/kg/day of clavulanate. 1
Weight-Based Calculation
This child weighs 45.9 kg (101 lbs ÷ 2.2 = 45.9 kg), which exceeds the 40 kg threshold where pediatric patients should be dosed according to adult recommendations 2
Using the high-dose regimen of 90 mg/kg/day: 45.9 kg × 90 mg/kg = 4,131 mg/day of amoxicillin 1
However, the absolute maximum daily dose is capped at 4,000 mg/day regardless of weight, so this child should receive 2,000 mg twice daily (every 12 hours) 1, 3
Rationale for High-Dose Regimen in Ear Infections
High-dose amoxicillin-clavulanate (90 mg/kg/day with 6.4 mg/kg/day clavulanate in 2 divided doses) is specifically indicated for acute otitis media in children with risk factors, including age <2 years, daycare attendance, recent antibiotic use within 30 days, or moderate to severe illness 1
The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which achieves middle ear fluid concentrations adequate to overcome penicillin-resistant Streptococcus pneumoniae (MICs of 2-4 mg/L) and β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 1, 4
Clinical trials demonstrated that high-dose amoxicillin-clavulanate eradicated penicillin-resistant S. pneumoniae with clinical response rates of 76-95% 1
Practical Administration
Since this child weighs >40 kg, adult formulations can be used: two 875 mg/125 mg tablets twice daily or two 500 mg/125 mg tablets three times daily 2
The twice-daily regimen (every 12 hours) is strongly preferred as it is associated with significantly less diarrhea than three-times-daily dosing 2, 5
The 14:1 ratio formulation causes less diarrhea than other amoxicillin-clavulanate preparations while maintaining efficacy 1
Treatment Duration and Monitoring
Complete a full 10-day course of therapy for acute otitis media 1, 2
Clinical improvement should be evident within 48-72 hours; if no improvement or worsening occurs after 72 hours, reevaluation and consideration of switching antibiotics or further investigation is necessary 1
Common adverse effects include diarrhea (25% vs 15% placebo), nausea, vomiting, and rash 1
Critical Pitfalls to Avoid
Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amounts of clavulanic acid and are not equivalent 2
Using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms 1
Verify the suspension concentration (if using liquid formulation) before calculating volume to avoid dosing errors 1