Augmentin 228 mg/5 ml Syrup
Introduction
I once received a prescription for a pediatric patient for Augmentin syrup at a dosage of 25 mg/kg three times daily.
- Upon review, I decided to intervene regarding the dosing frequency.
Interestingly, both the prescriber and I consulted the same reference, Frank Shann Drug Doses, which states the following:
- Dose as amoxicillin, oral. 4:1 (non-Duo products) 15-25 mg/kg (adult 500/125 mg) 8H; 7:1 (Duo) 20-30 mg/kg (adult 875/125 mg) 12 H; or 16:1 (XR) 30-50 mg/kg (adult 2000/125 mg) 12H.
However, the prescriber had overlooked that our facility's formulation (228 mg/5 ml) is a 7:1 formulation.
- Consequently, the clinically appropriate frequency for this child was twice daily (q12h), not three times daily (q8h).
Ratio and Frequency
Historically, Augmentin dosing frequency was determined strictly by the amoxicillin-to-clavulanate ratio: the 4:1 formulation was administered three times daily, while the 7:1 formulation was administered twice daily.
- Currently, facilities have the flexibility to standardize their specific dosage and frequency protocols.
According to Lexidrug, paediatric dosing for Augmentin syrup is based on the amoxicillin component, and the dose and frequency are product-specific.
- Not all formulations are interchangeable.
- Using a product with the incorrect amoxicillin:clavulanate ratio can result in subtherapeutic clavulanic acid concentrations or severe diarrhoea.
- Because the incidence of diarrhea increases with the clavulanate dose, some experts recommend not exceeding 10 mg clavulanate/kg/day or 125 mg clavulanate/dose.
- 4:1 formulation
- Infants <3 months: 30 mg amoxicillin/kg/day in divided doses every 12 hours.
- Infants ≥3 months, children and adolescents <40 kg: 20 to 45 mg amoxicillin/kg/day in divided doses every 8 to 12 hours; maximum daily dose: 1500 mg/day.
- 7:1 formulation: 20 to 45 mg amoxicillin/kg/day in divided doses every 8 to 12 hours; maximum daily dose: 1750 mg/day.
- 14:1 formulation: 90 mg/kg/day in divided doses every 12 hours; maximum daily dose: 4000 mg/day.
Volume Calculation
When calculating the final volume per dose, it is critical to divide the required dose by the amoxicillin content per ml, rather than the combined total mass of amoxicillin and clavulanate.
For a child weighing 10 kg prescribed 250 mg BD using Augmentin 228 mg/5 mL syrup:
- The "228 mg" label represents 200 mg of amoxicillin and 28 mg of clavulanate per 5 ml.
- Concentration of amoxicillin = 200 mg/5 ml = 40 mg/ml.
- Volume needed = 250 mg / 40 mg/ml = 6.25 ml.
Relevant Link
A separate post discussing how to properly reconstitute oral suspensions is available.
May I know if the patient is 11 months old and her weight is 7.7 kg, what is the dose for augmentin syrup 228mg/5ml?
ReplyDeleteAs discussed in the blog post, the dose according to Frank Shann is usually dosed based on amoxicillin component for 20-30 mg/kg (adult 875/125 mg) 12 H. On the other hand, Lexicomp suggested 25 to 45 mg amoxicillin/kg/day in divided doses twice daily; maximum daily dose: 1,750 mg/day. The dose is in a range, depending on clinician judgement on the severity. If you are not a healthcare professional, please consult your doctor or pharmacist for further info.
DeleteHi, thanks for your reply. I am a pharmacy student, I would like to clarify with you that 20-30 mg/kg q12h indicates 20-30mg/kg divided in BD dosing? '
DeleteHence, in this case, the dose should be 2.88 mL BD dosing, is it correct? Please correct me if I am wrong. Thank you.
30 mg x 7.7 kg = 231 mg
Dose = 231 mg x 5mL / 200 mg = 5.775 mL (divided by 2 = 2.88 mL )
Actually, the 20-30 mg/kg referred in Frank Shann is per dose. Hence, there is no need to divide the 5.775 ml by 2. Hope that clarifies it. The intervention that I am referring to is actually on the frequency of the augmentin syrup. =)
DeleteHi a pharmacy student here,
DeleteWondering what does duo and non-duo means?
Does the ratio of amoxicillin and clavulanate ratio automatically determines the dosing? For instant a 7:1 formulation is considered a duo product?
What makes the difference of dosing (in terms of frequency) between these two different formulation?
If you look across drug references, the dosing range and frequency of Augmentin is determined by the ratio.
DeleteSome refer duo products as products that are dosed BD, whereas non-duo products as those that are dosed TDS.
Tq for explain
ReplyDelete