Maximum Daily Dose of Clavulanate for an 8-Year-Old on Augmentin
The maximum daily dose of clavulanate for an 8-year-old child taking Augmentin is 10 mg/kg/day when using the standard three-times-daily formulation, or 6.4 mg/kg/day when using the high-dose twice-daily formulation. 1
Dosing Framework by Clinical Indication
Standard-Dose Regimen (Less Severe Infections)
- Clavulanate dose: 10 mg/kg/day divided into three doses (using 40 mg/kg/day amoxicillin component) 2
- This translates to approximately 3.3 mg/kg per dose given every 8 hours 2
- For an 8-year-old (typically 20-30 kg), this equals roughly 200-300 mg total daily clavulanate 1
High-Dose Regimen (Risk Factors Present)
- Clavulanate dose: 6.4 mg/kg/day divided into two doses (using 90 mg/kg/day amoxicillin component) 1
- This provides a 14:1 ratio of amoxicillin to clavulanate 1
- For an 8-year-old (20-30 kg), this equals approximately 128-192 mg total daily clavulanate 1
When to Use High-Dose vs. Standard-Dose
Use the high-dose regimen (6.4 mg/kg/day clavulanate) if ANY of these risk factors are present: 1
- Age under 2 years
- Daycare attendance 3
- Recent antibiotic use within the previous 30 days 1, 3
- Incomplete Haemophilus influenzae type b vaccination (less than 3 injections) 1
- Geographic area with high prevalence of penicillin-resistant S. pneumoniae (>10%) 1, 3
- Moderate to severe illness 1
- Concurrent purulent acute otitis media 1
Use standard-dose regimen (10 mg/kg/day clavulanate) for: 2
- Less severe infections without risk factors
- Uncomplicated respiratory tract infections in fully vaccinated children
Critical Dosing Considerations
The Clavulanate Paradox
The high-dose regimen actually delivers LESS total clavulanate per day (6.4 mg/kg/day) than the standard regimen (10 mg/kg/day), but provides MORE amoxicillin (90 vs. 40 mg/kg/day). 1 This 14:1 ratio formulation causes significantly less diarrhea while maintaining superior efficacy against resistant organisms 1, 4
Absolute Maximum Limits
- The FDA label does not specify an absolute maximum for clavulanate in pediatric patients, but the amoxicillin component is capped at 4000 mg/day 3, 5
- For practical purposes, this means the maximum clavulanate would be approximately 285 mg/day (when using the 14:1 high-dose formulation at maximum amoxicillin dose) 1
Common Pitfalls to Avoid
Never substitute formulations based on amoxicillin content alone - the clavulanate content varies significantly between preparations 2. For example:
- Two 250/125 mg tablets ≠ one 500/125 mg tablet (both contain 125 mg clavulanate, so you'd get double the clavulanate) 2
- The 250/125 mg tablet ≠ 250/62.5 mg chewable tablet (different clavulanate amounts) 2
Verify the suspension concentration before calculating volume - the 125/31 mg per 5 mL suspension differs from the 250/62 mg per 5 mL suspension 1. Using the wrong concentration leads to significant dosing errors.
Do not use adult dosing until the child weighs ≥40 kg 2. At that weight threshold, switch to adult dosing recommendations rather than continuing pediatric weight-based calculations 3.
Treatment Duration and Monitoring
- Standard treatment duration is 10 days for most respiratory infections including acute otitis media 1, 2
- Expect clinical improvement within 48-72 hours 1
- If no improvement or worsening after 72 hours, reevaluate the diagnosis and consider switching antibiotics 3
Adverse Effects Related to Clavulanate Dose
The most common adverse effect is diarrhea, which is directly related to clavulanate dose 1, 4:
- High-dose formulation (6.4 mg/kg/day): 7.2% incidence 6
- Standard three-times-daily formulation (10 mg/kg/day): 10.7% incidence 6
This explains why the high-dose twice-daily regimen with LESS clavulanate is better tolerated despite containing more amoxicillin 4, 7.