Maximum Dosing for Amoxicillin and Amoxicillin-Clavulanate

Patient Population: Pediatric

Although the absolute maximum Amoxicillin dose is 4000 mg/day, we recommend the following for usual maximum dosing when targeting a high dose (80-90 mg/kg/day): 

  • Amoxicillin suspension - usual maximum 2000 mg/day = 1000 mg/dose bid 
  • Amoxicillin tablet - usual maximum 875 mg/dose or 1000 mg/dose (2 of the 500mg tablets) 
  • Amoxicillin-clavulanate (Augmentin) suspension - usual maximum 2000 mg/day based on amoxicillin component. The recommended maximum dose of clavulanate component is 6.4 mg/kg/day. Different formulations are needed based on patient weight to keep within this recommended range.   
    • If patient weight < 40kg, use Augmentin-ES 600 mg/5ml formulation  
    • If patient weight >= 40kg, use regular Augmentin 400 mg/ml formulation 
  • Amoxicillin-clavulanate (Augmentin) tablet 
    • Usual maximum 875 mg amoxicillin/dose bid 
    • For acute bacterial sinusitis with high-risk features such as systemic illness, fever 39C or higher, or immunocompromised host, use maximum dose of 2000 mg amoxicillin/dose bid (2 of the 1000 mg XR tablets) 

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.