Augmentin Dosing for Persistent Otitis Media in Children
Rationale for High-Dose Amoxicillin-Clavulanate
- The American Academy of Pediatrics recommends high-dose amoxicillin-clavulanate (90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate) for persistent otitis media in children, as it provides superior coverage against β-lactamase-producing organisms, including Haemophilus influenzae and Moraxella catarrhalis, as well as drug-resistant Streptococcus pneumoniae 1, 2
- The 90/6.4 mg/kg/day formulation (14:1 ratio of amoxicillin to clavulanate) is effective against β-lactamase-producing Moraxella catarrhalis and drug-resistant Streptococcus pneumoniae, including penicillin-intermediate and some penicillin-resistant strains 1, 2
Practical Prescribing Details
- For an 11 kg child, the recommended dose is 990 mg amoxicillin component per day, divided into 2 doses of 495 mg twice daily, which can be achieved with Augmentin ES-600 (600 mg amoxicillin/42.9 mg clavulanate per 5 mL) 1, 2
Treatment Duration and Monitoring
- The American Academy of Pediatrics recommends a treatment duration of 10 days for persistent otitis media, with reassessment at 48-72 hours, and consideration of treatment failure and switch to intramuscular ceftriaxone (50 mg/kg/day for 3-5 days) if no improvement is seen 1, 3, 4
Common Pitfalls to Avoid
- The American Academy of Pediatrics advises against using standard-dose amoxicillin-clavulanate formulations (such as 40/10 mg/kg/day or 45/6.4 mg/kg/day) for persistent otitis media, as they provide inadequate coverage for resistant organisms 1, 2
- The American Academy of Pediatrics also advises against using the 7:1 ratio formulations (higher clavulanate content), as they significantly increase the risk of diarrhea without improving efficacy, and against using macrolides (azithromycin, clarithromycin) due to their inferior bacteriologic efficacy, with only 20-25% effectiveness against major AOM pathogens in persistent cases 1, 4