Augmentin Dosing for a 71-Pound Child
For a child weighing 71 pounds (32 kg), the standard Augmentin dose is 45 mg/kg/day of the amoxicillin component divided into two doses (approximately 720 mg twice daily), or 90 mg/kg/day divided into two doses (approximately 1,440 mg twice daily) for severe infections or high-risk situations. 1
Weight-Based Calculation
- A 71-pound child weighs approximately 32 kg 1
- Standard-dose regimen: 45 mg/kg/day = 1,440 mg total daily (720 mg twice daily) 1
- High-dose regimen: 90 mg/kg/day = 2,880 mg total daily (1,440 mg twice daily) 1
- Using a 400 mg/5 mL suspension, the standard dose equals approximately 9 mL twice daily, while the high dose equals approximately 18 mL twice daily 1
When to Use Standard vs High-Dose Regimen
Standard Dose (45 mg/kg/day) Indications
- Children ≥2 years with uncomplicated respiratory infections and no recent antibiotic exposure 1
- Acute bacterial sinusitis in children ≥2 years who do not attend daycare and have not received antibiotics in the past 4 weeks 1
- Mild to moderate infections without risk factors for resistant organisms 1
High Dose (90 mg/kg/day) Indications
Use the high-dose regimen when ANY of the following risk factors are present: 1, 2
- Age <2 years 1
- Daycare attendance 1
- Recent antibiotic use (within the past 30 days) 1
- Geographic area with >10% penicillin-resistant Streptococcus pneumoniae 1
- Moderate-to-severe illness at presentation 1
- Community-acquired pneumonia 1
- Incomplete Haemophilus influenzae type b vaccination 2
- Concurrent purulent acute otitis media 2
Specific Infection Dosing
Acute Otitis Media
- High-dose regimen: 90 mg/kg/day (1,440 mg twice daily) for 10 days 2
- This dosing achieves middle ear fluid concentrations adequate to overcome penicillin-resistant S. pneumoniae 2
Community-Acquired Pneumonia
- High-dose regimen: 90 mg/kg/day (1,440 mg twice daily) for 10 days 1, 2
- This applies to both children <5 years and ≥5 years with presumed bacterial pneumonia 1
Acute Bacterial Sinusitis
- Standard dose (45 mg/kg/day) for children ≥2 years without risk factors 1
- High dose (90 mg/kg/day) for children <2 years, daycare attendees, or recent antibiotic use 1
- Continue for 7 days after symptom resolution, with a minimum total of 10 days 1
Maximum Dosing Limits
- Maximum single dose: 2,000 mg per administration regardless of weight 2
- Maximum daily dose: 4,000 mg per day of the amoxicillin component 1
- For a 32 kg child, even the high-dose regimen (2,880 mg/day) remains well below these maximum limits 1
Treatment Duration and Monitoring
- Most respiratory infections require a 10-day course 1, 2
- Continue therapy for at least 48-72 hours after complete resolution of symptoms 1
- Clinical improvement should be evident within 48-72 hours of starting appropriate therapy 1, 2
- If no improvement occurs within 48-72 hours, reevaluate and consider atypical pathogens or complications 1
Administration Guidelines
- Augmentin may be taken without regard to meals, but absorption of clavulanate is enhanced when taken at the start of a meal 3
- To minimize gastrointestinal intolerance, administer at the start of meals 3
- The high-dose formulation provides a 14:1 ratio of amoxicillin to clavulanate, which minimizes diarrhea compared to other ratios 2
Common Pitfalls to Avoid
- Do not use twice-daily dosing of standard formulations for pneumonia—the high-dose twice-daily regimen is specifically required 1
- Do not substitute two 250 mg tablets for one 500 mg tablet—they contain different amounts of clavulanic acid and are not equivalent 3
- Do not underdose—using standard doses when high-dose therapy is indicated leads to treatment failure with resistant organisms 2
- Do not prescribe for viral infections—most upper respiratory infections are viral and do not benefit from antibiotics 2
- Verify the suspension concentration (125/31,250/62, or 400/57 mg per 5 mL) before calculating volume to avoid dosing errors 2