What is the appropriate dose of Augmentin (amoxicillin/clavulanate) for a 9-year-old patient weighing 77 pounds, given a concentration of 600mg per 5ml?

Augmentin Dosing for a 9-Year-Old, 77 Pounds

For a 9-year-old child weighing 77 pounds (35 kg), the appropriate dose of Augmentin 600mg/5mL suspension is 7.5 mL twice daily, providing 90 mg/kg/day of the amoxicillin component (1,575 mg twice daily). 1

Weight-Based Calculation

• The child weighs 77 pounds, which converts to 35 kg 1
• For most respiratory tract infections requiring Augmentin, the recommended dose is 90 mg/kg/day divided into 2 doses 1, 2
• Calculation: 35 kg × 90 mg/kg/day = 3,150 mg total daily dose 1
• This equals 1,575 mg per dose, given twice daily (every 12 hours) 1
• Using the 600mg/5mL concentration: 1,575 mg ÷ 600 mg = 2.625, then × 5 mL = 13.1 mL per dose 1

Critical Dosing Consideration

• However, this child weighs over 40 kg (88 pounds), which means adult dosing may be more appropriate 3
• For children weighing >40 kg, the American Academy of Pediatrics recommends transitioning to adult dosing regimens rather than continuing weight-based pediatric calculations 3
• The standard adult dose for respiratory infections is 875 mg twice daily or 500 mg three times daily 4

Indication-Specific Guidance

For Community-Acquired Pneumonia or Severe Respiratory Infections:

• Use the high-dose regimen of 90 mg/kg/day in 2 divided doses (maximum 4,000 mg/day) 1, 2
• This provides optimal coverage against penicillin-resistant Streptococcus pneumoniae and β-lactamase-producing organisms 2, 5

For Mild to Moderate Infections:

• 45 mg/kg/day in 2 doses may be sufficient (approximately 787.5 mg twice daily) 1
• This is appropriate for uncomplicated infections without risk factors for resistant organisms 1

High-Dose Regimen Indications

Use 90 mg/kg/day if any of these risk factors are present: 2

• Age <2 years (not applicable here)
• Daycare attendance 2
• Recent antibiotic use within past 30 days 2
• Incomplete Haemophilus influenzae type b vaccination 2
• Geographic area with high pneumococcal resistance (>10%) 2
• Moderate to severe illness 2

Treatment Duration and Monitoring

• Standard treatment duration is 10 days for respiratory infections 1, 2
• Clinical improvement should be evident within 48-72 hours; if no improvement occurs, reevaluation is necessary 1, 2
• Fever typically resolves within 24-48 hours for pneumococcal infections, though cough may persist longer 1

Common Pitfalls to Avoid

• Do not use the 600mg/5mL concentration with standard dosing calculations without verifying the total daily dose does not exceed 4,000 mg 1, 2
• Verify the suspension concentration before dispensing to avoid dosing errors 2
• For this weight (>40 kg), strongly consider using adult formulations (tablets) rather than suspension for better adherence and accuracy 3
• Subtherapeutic dosing promotes antimicrobial resistance and treatment failure 2

Practical Recommendation

Given this child's weight of 35 kg (77 lbs), the most practical approach is:

• Use Augmentin 875 mg tablets twice daily (adult formulation) for standard infections 4
• OR use 90 mg/kg/day (1,575 mg twice daily) if high-dose therapy is indicated based on risk factors 1, 2
• The 600mg/5mL suspension would require 13.1 mL twice daily for high-dose therapy, which is cumbersome; tablets are preferred at this weight 3