Can amoxicillin/clavulanate (Augmentin) 625 mg three times daily be given to a 17‑year‑old female weighing 55 kg?

Augmentin 625 mg TID Is Appropriate for a 17‑Year‑Old Female Weighing 55 kg

Yes, Augmentin 625 mg three times daily is an appropriate and safe dose for a 17‑year‑old female weighing 55 kg, provided the indication warrants antibiotic therapy. This regimen delivers approximately 34 mg/kg/day of amoxicillin, which falls within the standard adult dosing range and is suitable for most respiratory and soft‑tissue infections. 1

Weight‑Based Dosing Justification

• Adolescents weighing ≥40 kg should be dosed according to adult recommendations, and this patient at 55 kg clearly exceeds that threshold. 1
• The 625 mg formulation (typically 500 mg amoxicillin + 125 mg clavulanate) administered three times daily provides 1,500 mg total daily amoxicillin, which is the standard adult dose for moderate infections. 1
• For more severe respiratory tract infections, the FDA‑approved adult regimen is 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours, confirming that 625 mg TID (if this refers to a 500/125 formulation given three times daily) aligns with labeled dosing. 1

Indication‑Specific Considerations

• For respiratory tract infections (sinusitis, pneumonia, lower respiratory tract infections), the standard adult dose of amoxicillin/clavulanate is 500 mg/125 mg every 8 hours or 875 mg/125 mg every 12 hours. 1
• If the patient has risk factors for resistant organisms—such as recent antibiotic use, daycare exposure (less relevant at age 17), or residence in an area with >10% penicillin‑resistant S. pneumoniae—consider whether a higher‑dose regimen (875 mg BID) would be more appropriate. 2
• Most upper respiratory tract infections are viral and do not require antibiotics; ensure the patient meets criteria for bacterial infection (e.g., persistent symptoms >10 days, severe presentation, or "double sickening") before prescribing. 2

Treatment Duration and Monitoring

• Continue therapy for 7–10 days for most respiratory infections, with pneumonia specifically requiring 10 days. 2, 3
• Clinical improvement should be evident within 48–72 hours; if no improvement or worsening occurs, reassess the diagnosis and consider switching antibiotics or investigating for complications. 2, 4

Safety and Tolerability

• Amoxicillin/clavulanate is well tolerated, with the most common adverse effects being diarrhea (7–11%), nausea, vomiting, and rash. 2, 5
• The 14:1 ratio formulation (90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate) causes less diarrhea than other ratios while maintaining efficacy, though this high‑dose pediatric formulation is not necessary for a 55 kg adolescent dosed as an adult. 2

Common Pitfalls to Avoid

• Do not prescribe antibiotics for viral upper respiratory tract infections; isolated tympanic membrane redness without bulging or effusion does not meet criteria for bacterial otitis media. 2
• Verify the formulation before dispensing: the 625 mg tablet typically contains 500 mg amoxicillin + 125 mg clavulanate, but confirm the exact ratio to avoid dosing errors. 2
• Ensure renal function is normal; patients with creatinine clearance <30 mL/min require dose adjustment (500 mg/125 mg every 12 hours for CrCl 10–30 mL/min, or every 24 hours for CrCl <10 mL/min). 1

When to Consider Alternative Regimens

• If the patient has severe infection or documented resistant pathogens, escalate to 875 mg/125 mg every 12 hours (the higher adult dose). 1
• For penicillin allergy (non‑anaphylactic), second‑ or third‑generation cephalosporins (e.g., cefdinir, cefuroxime) are safe alternatives; for IgE‑mediated reactions, use clindamycin or a respiratory fluoroquinolone. 2, 3