Dosing Amoxicillin-Clavulanate Tablets in a 9-Year-Old When Suspension Is Unavailable
Yes, you can give three-quarters of a 625 mg amoxicillin-clavulanate tablet twice daily to this 30 kg child, which provides approximately 1,400 mg/day of amoxicillin—well within the recommended range for most pediatric infections.
Weight-Based Dose Calculation
For a 30 kg child, the standard dosing recommendations are:
- Standard-dose regimen: 45 mg/kg/day = 1,350 mg/day total (675 mg twice daily) 1
- High-dose regimen: 90 mg/kg/day = 2,700 mg/day total (1,350 mg twice daily) 1, 2
Your proposed regimen of three-quarters of a 625 mg tablet (≈469 mg amoxicillin per dose) twice daily delivers approximately 938 mg amoxicillin twice daily = 1,876 mg/day total, which falls between the standard and high-dose recommendations 1.
When This Dosing Is Appropriate
This intermediate dose is suitable for:
- Respiratory tract infections without high-risk features (age ≥2 years, no recent antibiotics, no daycare attendance) 1, 2
- Skin and soft tissue infections 2
- Urinary tract infections 3
The dose provides adequate coverage for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in most community settings 2, 4.
When You Need the Full High-Dose Regimen
Switch to one full 625 mg tablet twice daily (1,250 mg/day total amoxicillin) if the child has any of these risk factors:
- Age <2 years 2
- Daycare attendance 2
- Antibiotic use within the past 30 days 2
- Severe infection presentation 1, 2
- Geographic area with >10% penicillin-resistant S. pneumoniae 1
- Incomplete Haemophilus influenzae type b vaccination 2
- Community-acquired pneumonia 1, 2
The high-dose regimen (90 mg/kg/day) achieves tissue concentrations that overcome penicillin-resistant S. pneumoniae with MICs up to 2–4 mg/L 2.
Practical Administration
- Divide the tablet as accurately as possible using a pill cutter; slight variations (±10%) are clinically acceptable 5
- Administer at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 5
- Treatment duration: 7–10 days for most infections; 10 days specifically for pneumonia and acute otitis media 1, 2
Monitoring and Expected Response
- Clinical improvement should occur within 48–72 hours (reduced fever, improved symptoms) 1, 2
- If no improvement or worsening after 48–72 hours: reassess the diagnosis, consider atypical pathogens, evaluate for complications, or switch to alternative therapy 1, 2
Critical Caveats
Do not use this approach if:
- The child weighs <40 kg and requires the adult 250/125 mg tablet formulation, because the clavulanate ratio differs from pediatric formulations 5
- The child has severe renal impairment (GFR <30 mL/min), which requires dose adjustment 5
- You are treating acute otitis media in a child <2 years, where the full high-dose regimen (90 mg/kg/day) is mandatory 2
Maximum daily dose: Do not exceed 4,000 mg/day of amoxicillin regardless of weight 1.
Why Tablets Can Replace Suspension
The FDA label explicitly permits using suspension formulations in place of tablets for adults who have difficulty swallowing, confirming bioequivalence between formulations 5. Pediatric studies demonstrate that amoxicillin absorption from tablets is equivalent to suspension when adjusted for dose 6, 7. The key is accurate weight-based dosing, not the formulation itself 8.
Common pitfall: Prescribers sometimes underdose when using tablets in children because they default to adult dosing rather than calculating the weight-based pediatric dose 8. Always calculate mg/kg/day first, then determine how to achieve that dose with available formulations 1, 8.