augmentin liquid for peds 90 mg/kg?

[storyhill2]

What do you guys do when you are asked about dosing augmentin liquid for kids with acute otitis media. The docs usually want to go with 90 mg/kg but when they calculate the dose they come walking over to me because the dose is usually a lot more than an adult dose for the same indication. It's isn't hard to get into the 4000-6000 mg/day dosing.

Lexicomp states "Maximum dose has not been established for AOM; however, 4,000 mg/day has been suggested"

My answer if usually to state what lexicomp says and say it's a grey area. I try to get them to cap it when they get above 4000 mg.

What say you guys?

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[owlegrad]

I can’t speak to this exact scenario but I seem to recall learning in general that you only use pediatric doses until the dose becomes the adult dose -I.e., do not exceed the adult dose.

 

[VA Hopeful Dr]

I can’t speak to this exact scenario but I seem to recall learning in general that you only use pediatric doses until the dose becomes the adult dose -I.e., do not exceed the adult dose.

This is roughly my practice.

 

[Dred Pirate]

for peds I get them to cap it at 4 grams, our EPIC system is set up to cap it, but every know and then a peds abx comes through (in patient/ ED) that for some reason slips through the epic caps (decadron for example) and I either change it/cap it or call them to change it (depending on the doc)

 

[RXDOC1986]

Pediatric ICU pharmacist for 10+ years. Mg/Kg dosing is appropriate only up to established max doses. We also used EPIC, most often than not, residents, fellows and some attendings would just do mg/kg, not paying attention to max doses. They would defer to pharmacy, for dose adjustments.

 

[KidPharmD]

Current Pediatric ED Pharmacist - The maximum dose for AOM is not established. However, the other place we dose at 80-90 mg/kg/day is CAP where the maximum single dose is 2000mg. That is what we use for AOM. There is no evidence for higher dosing than that.

The adage that pediatric dosing should stop at adult dosing is a good rule of thumb but doesn't apply in every scenario. This is one of those cases.

 

[VA Hopeful Dr]

Current Pediatric ED Pharmacist - The maximum dose for AOM is not established. However, the other place we dose at 80-90 mg/kg/day is CAP where the maximum single dose is 2000mg. That is what we use for AOM. There is no evidence for higher dosing than that.

The adage that pediatric dosing should stop at adult dosing is a good rule of thumb but doesn't apply in every scenario. This is one of those cases.

Is there evidence for either condition that exceeding adult doses improves outcomes?

 

[WVUPharm2007]

I say give the highest dose you can justify for CYA purposes via malicious compliance as a means of corporal punishment. If the little bastards got horrific diarrhea every time they got *another* respiratory infection then maybe they'd wash their hands more and not go around coughing in each other's damn faces. Also, fewer parents would have an excuse to get a free vacation day because little Timmy is sick again.

 

[Dred Pirate]

Also, fewer parents would have an excuse to get a free vacation day because little Timmy is sick again.

as a parent- there is nothing "Free" about a day home with a sick kiddo. We have to use our PDO and get "ding" in our employee file for calling out. I would much rather save those vacation days for a beach in Mexico than at home with a snotty, puking, pissed off toddler

 

[storyhill2]

Current Pediatric ED Pharmacist - The maximum dose for AOM is not established. However, the other place we dose at 80-90 mg/kg/day is CAP where the maximum single dose is 2000mg. That is what we use for AOM. There is no evidence for higher dosing than that.

The adage that pediatric dosing should stop at adult dosing is a good rule of thumb but doesn't apply in every scenario. This is one of those cases.

great point. I actually have never seen an order where they used it for CAP but I do see now it is FDA approved for that and i see that capped dose recommendation. Interesting there is a max for CAP but not for AOM. Thanks for the insight.