Augmentin 228 mg/5 ml Syrup
Introduction
Once, I received a prescription for a child requiring Augmentin syrup at a dosage of 25 mg/kg three times daily.
- I decided to intervene regarding the frequency of dosing.
Surprisingly, 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 overlooked the fact that our formulation (228 mg/5 ml) is a 7:1 formulation.
- Therefore, the correct frequency of dosing for this child was 2 times daily, not 3 times daily.
Ratio and Frequency
According to Lexicomp, paediatric dosing of Augmentin syrup is based on the amoxicillin component, and the dose and frequency are product-specific.
- Not all products are interchangeable.
- Using a product with the incorrect amoxicillin:clavulanate ratio could result in subtherapeutic clavulanic acid concentrations or severe diarrhoea.
- 2:1 formulation is dosed 3 times daily.
- 4:1 formulation is dosed 3 times daily.
- 7:1 formulation is dosed 2 times daily.
- 14:1 formulation is dosed 2 times daily.
- 16:1 formulation (extended release) is dosed 2 times daily.
Volume Calculation
When calculating the final volume needed per dose, it is important to divide the calculated dose over amoxicillin content per ml, NOT the total content of amoxicillin and clavulanate per ml.
- For example, the final volume needed per dose for a child weighing 10 kg (250 mg BD) who is taking Augmentin 228 mg/5ml syrup is 6.25 ml, not 5 ml.
Relevant Link
A separate post discussing how to reconstitute oral suspension 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