Recommended Dosage of Amoxicillin/Clavulanate (Amoxclav) Tablets
The recommended adult dose of amoxicillin/clavulanate (Amoxclav) tablets is 875 mg/125 mg twice daily or 500 mg/125 mg three times daily for standard infections, with high-dose formulations of 2000 mg/125 mg twice daily available for more severe respiratory infections or resistant pathogens. 1, 2
Adult Dosing Recommendations
Standard Dosing
- Regular strength:
- 875/125 mg twice daily OR
- 500/125 mg three times daily 1
- Duration: 5-7 days for most respiratory infections in adults 2
High-Dose Formulations
- Enhanced formulation: 2000/125 mg twice daily (Augmentin XR) for:
Pediatric Dosing Recommendations
- Standard dosing: 45 mg/kg/day of amoxicillin component in divided doses every 12 hours 2
- High-dose formulation: 90 mg/kg/day of amoxicillin component in two divided doses (Augmentin ES-600) 3
- Duration: 10-14 days recommended for children 2
Dosing Based on Infection Type
Respiratory Tract Infections
- Mild/Moderate: 875 mg every 12 hours or 500 mg every 8 hours 1
- Severe: 875 mg every 12 hours or 500 mg every 8 hours 1
Skin/Skin Structure Infections
- Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours 1
- Severe: 875 mg every 12 hours or 500 mg every 8 hours 1
Dosing in Special Populations
Renal Impairment
- GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours (depending on infection severity)
- GFR <10 mL/min: 500 mg or 250 mg every 24 hours (depending on infection severity)
- Hemodialysis: 500 mg or 250 mg every 24 hours plus additional dose during and after dialysis 1
- Note: Patients with GFR <30 mL/min should NOT receive the 875 mg dose 1
Clinical Considerations
- Take at the start of a meal to minimize gastrointestinal intolerance 1
- For S. pyogenes (Group A Streptococcus) infections, treatment should continue for at least 10 days to prevent acute rheumatic fever 1
- The pharmacokinetically enhanced formulation (2000/125 mg) maintains plasma amoxicillin concentrations above 4 μg/mL for approximately 49% of the dosing interval, making it effective against S. pneumoniae with higher MICs 4
- Clinical studies have shown that a 5-day course of high-dose amoxicillin-clavulanate (2000/125 mg) is as effective as a 7-day course of conventional dosing (875/125 mg) for acute exacerbations of chronic bronchitis 5
Common Pitfalls to Avoid
- Do not confuse the pediatric high-dose formulation (90 mg/kg/day) with standard dosing (45 mg/kg/day) 3
- The 250 mg and 500 mg tablets contain the same amount of clavulanic acid (125 mg), so two 250 mg tablets are not equivalent to one 500 mg tablet 2
- Ensure complete course of therapy is taken, even if symptoms improve before completion
- For patients with penicillin allergy, alternative antibiotics should be considered rather than amoxicillin/clavulanate 6
Amoxicillin/clavulanate remains a cornerstone antibiotic for community-acquired infections, with various formulations designed to address the growing concern of antimicrobial resistance while maintaining excellent clinical efficacy 7.