Augmentin Dosing for Pediatric Sinusitis

Rationale for High-Dose Augmentin

The American Academy of Pediatrics recommends high-dose amoxicillin-clavulanate (Augmentin) at 80-90 mg/kg/day of the amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses for children younger than 2 years with sinusitis, as they are at higher risk for harboring resistant organisms 1, 2, 3
High-dose amoxicillin-clavulanate effectively targets β-lactamase-producing H. influenzae and M. catarrhalis as well as potentially resistant S. pneumoniae 2, 4
The potassium clavulanate component provides adequate coverage against β-lactamase-producing pathogens 3, 5

The total daily dose of Augmentin should be administered in 2 divided doses 3, 4
Treatment should continue for 10-14 days 6
Some guidelines suggest continuing treatment until 7 days after the patient becomes free of signs and symptoms 3

For children who cannot tolerate oral medication or who are vomiting, a single 50 mg/kg dose of ceftriaxone can be given intravenously or intramuscularly 1, 3
If clinical improvement is observed at 24 hours after ceftriaxone, an oral antibiotic can be substituted to complete the course 3

Clinical improvement should be assessed at 3-5 days after starting treatment 6
If no improvement is seen after 3-5 days, consider changing antibiotics or reevaluating the diagnosis 6
Children who remain significantly febrile or symptomatic at 24 hours after parenteral therapy may require additional doses 3

Risk factors for resistant organisms in pediatric patients include age younger than 2 years 1, 2, 3
Recent antibiotic exposure (within previous 30 days) is also a risk factor for resistant organisms 3
The high-dose amoxicillin component achieves sinus fluid concentrations adequate to overcome resistance in S. pneumoniae 3