What is the maximum dose of Augmentin (amoxicillin/clavulanate) for a patient weighing 79 lb (≈36 kg)?

Maximum Augmentin Dose for 79 Pounds (36 kg)

For a child weighing 79 pounds (36 kg), the maximum dose of Augmentin is 90 mg/kg/day of the amoxicillin component divided into two doses, which equals 3,240 mg/day total (1,620 mg twice daily), using the high-dose formulation. 1

Dosing Algorithm Based on Clinical Scenario

For Moderate-to-Severe Infections or High-Risk Patients

• Use high-dose amoxicillin-clavulanate: 90 mg/kg/day of the amoxicillin component divided twice daily 2
• For this 36 kg child: 1,620 mg twice daily (3,240 mg/day total) 1
• High-risk factors include: age <2 years, daycare attendance, or antibiotic use within past 30 days 2
• This dosing applies to acute bacterial sinusitis, otitis media, and community-acquired pneumonia in children with suspected resistant pathogens 2

For Mild-to-Moderate Uncomplicated Infections

• Standard dose: 45 mg/kg/day divided twice daily may be used in children ≥2 years without risk factors 2
• For this 36 kg child: 810 mg twice daily (1,620 mg/day total)
• This applies only when local penicillin-nonsusceptible S. pneumoniae prevalence is <10% 2

Critical Formulation Considerations

The ES-600 formulation (90 mg/kg/day) contains different clavulanate ratios and is NOT interchangeable with standard Augmentin suspensions. 1

• ES-600 provides 42.9 mg clavulanate per 5 mL 1
• Standard 400 mg/5 mL suspension contains 57 mg clavulanate per 5 mL 1
• For a 36 kg child on ES-600: 13.5 mL twice daily 1

Maximum Dose Ceiling

While weight-based dosing may exceed standard adult doses, the evidence supports using calculated pediatric doses up to 4,000 mg/day of amoxicillin component in children. 2

• Pediatric guidelines explicitly state maximum of 4 g/day for children ≥5 years 2
• For this 36 kg child, the calculated 3,240 mg/day remains below this ceiling 2
• Research demonstrates that achieving plasma concentrations above MIC for ≥34% of dosing interval provides efficacy against resistant S. pneumoniae strains 3

Common Prescribing Pitfall

Physicians frequently underdose amoxicillin in heavier children, prescribing standard adult doses instead of weight-based calculations. 4

• A 2010 study found primary care physicians prescribed significantly lower doses in higher-weight children 4
• Even guideline committee members disagreed on whether to cap doses at adult maximums 4
• For optimal outcomes against resistant pathogens, use the full weight-based dose of 90 mg/kg/day up to 4,000 mg/day 2

Administration Requirements

• Give at the start of meals to minimize gastrointestinal intolerance and enhance clavulanate absorption 1
• Reconstituted suspension remains stable for 10 days under refrigeration 1
• Improper storage (especially heat exposure) degrades the antibiotic and causes treatment failure 5