Augmentin Dosing for Streptococcal Pharyngitis in a 71‑lb (32‑kg) Child
Augmentin is NOT first‑line therapy for uncomplicated streptococcal pharyngitis—amoxicillin alone at 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days is the preferred treatment due to proven efficacy, narrow spectrum, safety, and low cost. 1
When Augmentin Should NOT Be Used
Penicillin or amoxicillin remains the drug of choice for all non‑allergic patients with acute Group A streptococcal pharyngitis, with strong, high‑quality evidence supporting its use and no documented penicillin resistance in Group A Streptococcus anywhere in the world. 1, 2
Augmentin unnecessarily broadens the antimicrobial spectrum and increases cost without improving outcomes in standard acute strep throat, making it inappropriate as first‑line therapy. 1
When Augmentin IS Indicated for Strep
Augmentin should be reserved for chronic Group A streptococcal carriers with recurrent symptomatic episodes who have failed standard penicillin or amoxicillin therapy. 3
Specific Dosing for Chronic Carriers (32‑kg child):
Prescribe 40 mg/kg/day of the amoxicillin component divided into three doses (maximum 2000 mg amoxicillin per day) for 10 days. 3
For a 32‑kg child, this equals approximately 1280 mg amoxicillin per day, divided into three doses of ~427 mg each. 3
The practical prescription would be 500 mg/125 mg Augmentin three times daily for 10 days (providing 1500 mg amoxicillin/day, which is within the recommended range). 3, 4
Critical Treatment Requirements
A full 10‑day course is mandatory to achieve maximal pharyngeal eradication of Group A Streptococcus and prevent acute rheumatic fever, even if symptoms resolve within 3–4 days. 1, 2
Shortening the course by even a few days results in appreciable increases in treatment failure rates and rheumatic fever risk. 1, 2
Preferred First‑Line Regimen (For This 32‑kg Child)
For uncomplicated acute streptococcal pharyngitis, prescribe amoxicillin 800 mg (25 mg/kg) twice daily for 10 days (or 1600 mg once daily if adherence is a concern). 1, 2
Alternative Regimens for Penicillin Allergy
For non‑anaphylactic penicillin allergy: First‑generation cephalosporins such as cephalexin 640 mg (20 mg/kg) twice daily for 10 days are preferred, with strong, high‑quality evidence and only 0.1% cross‑reactivity risk. 1, 5, 2
For immediate/anaphylactic penicillin allergy: Clindamycin 224 mg (7 mg/kg) three times daily (maximum 300 mg per dose) for 10 days is the optimal choice, with only ~1% resistance among Group A Streptococcus in the United States. 1, 5, 2
Azithromycin 384 mg (12 mg/kg) once daily (maximum 500 mg) for 5 days is an acceptable alternative, but macrolide resistance is 5–8% in the United States and varies geographically. 1, 5, 2
Common Pitfalls to Avoid
Do not prescribe Augmentin for standard acute streptococcal pharyngitis—it provides no advantage over amoxicillin alone and unnecessarily increases cost and side effects. 1, 3
Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as this results in excessive clavulanate dosing (250 mg instead of 125 mg) and increases gastrointestinal side effects. 4
Do not shorten the treatment course below 10 days (except for azithromycin's 5‑day regimen), as this dramatically increases treatment failure and rheumatic fever risk. 1, 2
Adjunctive Symptomatic Treatment
Acetaminophen or ibuprofen can be offered for moderate to severe symptoms or high fever, with strong, high‑quality evidence for reducing pain and inflammation. 1, 5, 2
Aspirin must be avoided in children due to the risk of Reye syndrome. 1, 5, 2
Corticosteroids are not recommended as adjunctive therapy. 1, 5, 2