Augmentin ES-600 Dosing for 45 lb Child with Acute Otitis Media
For a 45 lb (approximately 20 kg) child with acute otitis media, administer Augmentin ES-600 (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) at 10 mL twice daily for 10 days, providing 90 mg/kg/day of amoxicillin.
Dosing Calculation
- Child's weight: 45 lb = 20.4 kg 1
- Recommended dose: 90 mg/kg/day of amoxicillin component divided into 2 doses 1, 2
- Total daily amoxicillin: 20.4 kg × 90 mg/kg = 1,836 mg/day
- Per dose: 918 mg amoxicillin twice daily
- Volume per dose: Approximately 10 mL of ES-600 suspension twice daily 2
This provides the high-dose amoxicillin-clavulanate regimen (90/6.4 mg/kg/day) in a 14:1 ratio that is specifically designed for acute otitis media 1, 2.
Clinical Rationale
High-dose amoxicillin-clavulanate is the preferred first-line treatment for children with acute otitis media who:
- Have received amoxicillin in the previous 30 days 1
- Are younger than 2 years with bilateral AOM 1
- Have concurrent purulent conjunctivitis (otitis-conjunctivitis syndrome) 1
- Require coverage for β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 1
The ES-600 formulation achieves 96-98% bacteriologic eradication rates against Streptococcus pneumoniae (including penicillin-resistant strains with MICs of 2-4 mcg/mL) and 92-94% eradication of H. influenzae 2, 3.
Treatment Duration and Monitoring
- Duration: 10 days of therapy 1, 2
- Clinical assessment: Evaluate treatment response at 48-72 hours 1
- Treatment failure criteria: Lack of improvement or worsening after 48-72 hours warrants consideration of alternative therapy (ceftriaxone 50 mg/kg IM/IV daily for 3 days) 1
Safety Profile
The ES-600 formulation has a favorable safety profile with protocol-defined diarrhea occurring in approximately 11-13% of children, which is comparable to standard-dose formulations 2. The 14:1 ratio of amoxicillin to clavulanate minimizes gastrointestinal side effects while maintaining β-lactamase inhibition 2, 4.
Common adverse effects include:
Alternative Considerations
If the child has taken amoxicillin within the past 30 days or has moderate-to-severe illness, high-dose amoxicillin-clavulanate is specifically indicated over standard-dose amoxicillin 1, 5. For children with true penicillin allergy (not just intolerance), alternative agents include cefdinir (14 mg/kg/day) or ceftriaxone 1.
The WHO guidelines recommend amoxicillin 40 mg/kg twice daily for uncomplicated acute otitis media in resource-limited settings 6, but current U.S. guidelines favor the higher 80-90 mg/kg/day dosing to address increasing antimicrobial resistance 1.