What is the recommended intravenous amoxicillin‑clavulanate (Augmentin) dose and dosing interval for a 25 kg, 11‑year‑old girl?

IV Augmentin Dosing for a 25 kg, 11-Year-Old Girl

For intravenous amoxicillin-clavulanate in a 25 kg, 11-year-old child, administer 30 mg/kg three times daily (every 8 hours), which equals 750 mg IV every 8 hours (2,250 mg total daily dose). 1

Weight-Based IV Dosing Calculation

• The standard IV dose for pediatric patients of all ages is 30 mg/kg three times daily, administered by short intravenous infusion 1, 2
• For this 25 kg patient: 25 kg × 30 mg/kg = 750 mg per dose, given every 8 hours 1
• Total daily dose = 2,250 mg/day 1

Administration Guidelines

• Administer each dose as a short IV infusion over 15-30 minutes 2
• The dosing interval of every 8 hours (three times daily) maintains therapeutic serum concentrations throughout the day 1, 2
• Historical studies used dosing ranges of 100-200 mg/kg/day divided into 3-4 doses for severe infections, but current guidelines standardize at 30 mg/kg three times daily 2

Clinical Monitoring and Expected Response

• Clinical improvement should be evident within 48-72 hours of initiating IV therapy 3, 1
• If no improvement or clinical worsening occurs after 48-72 hours, reassess the diagnosis and consider alternative pathogens or complications 3, 1
• Fever typically resolves within 24-48 hours for pneumococcal infections, though cough may persist longer 3

Duration of IV Therapy

• Continue IV therapy for 7-10 days for most respiratory tract infections 4
• For bacterial pneumonia specifically, 10 days of total antibiotic therapy is recommended 4
• Consider switching to oral therapy once the patient demonstrates clinical improvement, is afebrile for 24-48 hours, and can tolerate oral intake 4

Transition to Oral Therapy

• When transitioning from IV to oral, use high-dose oral amoxicillin-clavulanate at 90 mg/kg/day divided into 2 doses (maximum 4,000 mg/day) 3, 1
• For this 25 kg patient, oral dosing would be: 25 kg × 90 mg/kg = 2,250 mg/day, administered as 1,125 mg twice daily 1, 4

Indication-Specific Considerations

For Community-Acquired Pneumonia

• IV therapy is appropriate for children requiring hospitalization due to severe illness, inability to tolerate oral intake, or failure of outpatient oral therapy 3, 4
• The 30 mg/kg three times daily IV regimen provides adequate coverage for Streptococcus pneumoniae (including penicillin-resistant strains), β-lactamase-producing Haemophilus influenzae, and Moraxella catarrhalis 4, 5

For Complicated Intra-Abdominal Infections

• Higher IV dosing of 200 mg/kg/day of the ampicillin component given every 6 hours may be indicated for complicated intra-abdominal infections 3
• This would equal 1,250 mg every 6 hours for a 25 kg child 3

Renal Function Adjustment

• In patients with renal insufficiency, prolong the dosing interval according to creatinine clearance to avoid drug accumulation 4
• Both amoxicillin and clavulanic acid are renally eliminated, requiring dose reduction in altered renal function 4

Safety and Tolerability

• IV amoxicillin-clavulanate is generally well tolerated in children 2
• The most common adverse effects are mild, transient gastrointestinal disturbances 3, 4
• Historical studies demonstrated complete clinical cure or distinct improvement in all assessable pediatric cases receiving IV therapy 2

Common Pitfalls to Avoid

• Do not underdose: Using lower than recommended doses (e.g., 20 mg/kg) fails to achieve adequate serum concentrations against resistant organisms 1
• Verify the indication: Most upper respiratory tract infections are viral and do not require IV antibiotics 1
• Do not delay transition to oral therapy: Once clinical improvement is evident and oral intake is tolerated, continuing IV therapy unnecessarily increases costs and risks without added benefit 4