Augmentin 200-28.5/5mL Dosing for a 15-kg Child
For a 15-kg child, administer 6.75 mL of Augmentin 200-28.5/5mL suspension twice daily (every 12 hours) for standard infections, or 10 mL twice daily for more severe infections or recent antibiotic exposure.
Standard Dosing Calculation
The Augmentin 200-28.5/5mL formulation contains 200 mg amoxicillin and 28.5 mg clavulanate per 5 mL. For pediatric patients ≥3 months old, dosing is based on the amoxicillin component 1.
For Standard-Dose Therapy (45 mg/kg/day):
- Target dose: 45 mg/kg/day of amoxicillin divided into 2 doses
- Calculation for 15-kg child: 45 mg/kg/day × 15 kg = 675 mg/day total
- Per dose: 675 mg ÷ 2 = 337.5 mg per dose
- Volume needed: (337.5 mg ÷ 200 mg) × 5 mL = 6.75 mL twice daily
For High-Dose Therapy (90 mg/kg/day):
- Target dose: 90 mg/kg/day of amoxicillin divided into 2 doses 2, 3
- Calculation for 15-kg child: 90 mg/kg/day × 15 kg = 1,350 mg/day total
- Per dose: 1,350 mg ÷ 2 = 675 mg per dose
- Volume needed: (675 mg ÷ 200 mg) × 5 mL = 10 mL twice daily
When to Use High-Dose vs Standard-Dose
Use high-dose amoxicillin-clavulanate (90 mg/kg/day = 10 mL twice daily) for:
- Children <2 years old 4, 5
- Recent antibiotic use within the past 30 days 4, 5
- Daycare attendance 4
- Moderate to severe illness 4
- Geographic areas with high penicillin-resistant Streptococcus pneumoniae (>10% resistance) 2, 3
- β-lactamase-producing Haemophilus influenzae suspected 2, 3
Use standard-dose (45 mg/kg/day = 6.75 mL twice daily) for:
- Children ≥2 years old with mild-to-moderate uncomplicated infections
- No recent antibiotic exposure
- No daycare attendance
- Low local resistance patterns 4
Administration Guidelines
- Timing: Administer at the start of meals to minimize gastrointestinal side effects and enhance clavulanate absorption 1
- Frequency: Every 12 hours (twice daily dosing)
- Duration: Typically 7-10 days depending on infection type 3, 6
- Storage: Refrigerate after reconstitution; stable for 10 days 1
- Shake well before each use 1
Important Caveats
Non-Interchangeability Warning
The 200-28.5/5mL formulation is NOT interchangeable with other Augmentin suspensions 1. The 200 mg/5 mL contains 28.5 mg clavulanate per 5 mL, whereas:
- The 400 mg/5 mL contains 57 mg clavulanate per 5 mL
- The ES-600 contains 42.9 mg clavulanate per 5 mL
These different clavulanate ratios mean you cannot substitute one formulation for another based solely on amoxicillin content.
Compliance Advantage
Twice-daily dosing shows superior compliance (82.8%) compared to three-times-daily regimens (73.3%), with equivalent or superior efficacy 7, 8. The twice-daily formulation also demonstrates significantly lower rates of diarrhea (9.6% vs 26.7%) compared to three-times-daily dosing 8.
Resistance Considerations
For β-lactamase-producing organisms (H. influenzae, M. catarrhalis), the clavulanate component provides essential coverage 2, 3. Current data shows 58-82% of H. influenzae isolates remain susceptible to amoxicillin alone, making the clavulanate addition clinically important 5.