What is the appropriate dose of Augmentin (amoxicillin/clavulanate) 400 mg per 5 ml oral suspension for a child weighing 10.3 kg?

Augmentin 400mg/5ml Dosing for a 10.3kg Child

For a child weighing 10.3 kg, administer 4.6 mL of Augmentin 400mg/5ml suspension twice daily (every 12 hours) for standard infections, or 9.3 mL twice daily for high-dose therapy when risk factors for resistant organisms are present. 1

Weight-Based Calculation

Standard-Dose Regimen (45 mg/kg/day)

• The standard dose is 45 mg/kg/day of the amoxicillin component divided into 2 doses, which equals 463 mg per day for a 10.3 kg child 1
• Each dose is 231.5 mg of amoxicillin, which corresponds to approximately 4.6 mL of the 400mg/5ml suspension twice daily 1

High-Dose Regimen (90 mg/kg/day)

• The high-dose regimen is 90 mg/kg/day of the amoxicillin component divided into 2 doses, which equals 927 mg per day for a 10.3 kg child 1
• Each dose is 463.5 mg of amoxicillin, which corresponds to approximately 9.3 mL of the 400mg/5ml suspension twice daily 1

When to Use High-Dose Therapy

Use the high-dose regimen (9.3 mL twice daily) if ANY of the following risk factors are present:

• Age < 2 years (this 10.3 kg child is likely under 2 years) 1
• Daycare attendance 1
• Recent antibiotic use within the past 30 days 1
• Incomplete Haemophilus influenzae type b vaccination (less than 3 injections) 1
• Geographic area with high prevalence of penicillin-resistant S. pneumoniae (>10%) 1
• Moderate-to-severe illness at presentation 1
• Concurrent purulent acute otitis media 1

Indication-Specific Dosing

Community-Acquired Pneumonia

• For children < 5 years with presumed bacterial pneumonia, use 90 mg/kg/day (9.3 mL twice daily) 1, 2
• Treatment duration is 10 days 3

Acute Otitis Media

• For children < 2 years with AOM, use 90 mg/kg/day (9.3 mL twice daily) 1
• Treatment duration is 10 days 4

β-lactamase-Producing Organisms

• For H. influenzae or M. catarrhalis infections, use either 45 mg/kg/day in 3 doses OR 90 mg/kg/day in 2 doses 3
• The twice-daily regimen is preferred as it is associated with significantly less diarrhea 4

Practical Administration

• Administer every 12 hours (twice daily dosing) 1, 4
• The 400mg/5ml suspension provides a 14:1 ratio of amoxicillin to clavulanate, which minimizes diarrhea compared to other formulations 1
• Doses may be given with or without food 4

Treatment Duration and Monitoring

• Standard duration is 10 days for most respiratory infections 3, 1
• Clinical improvement should occur within 48-72 hours; if no improvement or worsening occurs, reevaluate and consider switching antibiotics or investigating for complications 1
• Fever typically resolves within 24-48 hours for pneumococcal infections, though cough may persist longer 2

Critical Pitfalls to Avoid

• Do not use standard-dose therapy when high-dose is indicated—this leads to treatment failure with resistant organisms and promotes antimicrobial resistance 1
• Do not substitute different formulations—the 400mg/5ml suspension is specifically designed for the high-dose regimen with the optimal 14:1 ratio 1, 4
• Do not discontinue early even if symptoms improve—complete the full 10-day course to prevent relapse and reduce resistance 1
• Verify the suspension concentration before dispensing to avoid dosing errors 1

Age Restriction

• Augmentin may be initiated in children ≥ 3 months of age when bacterial infection is suspected or confirmed 1
• For infants < 3 months with serious bacterial infection, intravenous regimens (ampicillin + gentamicin or cefotaxime) are preferred over oral Augmentin 1