What is the recommended dose of amoxicillin (amoxicillin)-clavulanate tablet?

Recommended Dosage of Amoxicillin-Clavulanate Tablets

The standard adult dose of amoxicillin-clavulanate is 500 mg/125 mg every 12 hours or 875 mg/125 mg every 12 hours for more severe infections, taken at the start of a meal to minimize gastrointestinal intolerance. 1

Adult Dosing Options

• Standard infections:

  • 500 mg/125 mg tablet every 12 hours 1
  • 250 mg/125 mg tablet every 8 hours 1

• More severe infections and respiratory tract infections:

  • 875 mg/125 mg tablet every 12 hours 1
  • 500 mg/125 mg tablet every 8 hours 1

• High-dose formulation (for resistant organisms):

  • 2000 mg/125 mg (pharmacokinetically enhanced) twice daily 2, 3
  • Particularly useful for penicillin-resistant Streptococcus pneumoniae 3

Pediatric Dosing

• Neonates and infants <12 weeks: 30 mg/kg/day divided every 12 hours (based on amoxicillin component) 1

• Children ≥12 weeks:

  • More severe infections: 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours 1
  • Less severe infections: 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours 1
  • High-dose formulation: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses 2

• Children weighing ≥40 kg: Use adult dosing recommendations 1

Special Considerations

Renal Impairment Adjustments

• GFR <30 mL/min: Do not use 875 mg/125 mg dose 1
• GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours 1
• GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours 1
• Hemodialysis patients: 500 mg/125 mg or 250 mg/125 mg every 24 hours, plus additional dose during and at end of dialysis 1

When to Consider Higher Doses

Higher doses (such as 875 mg/125 mg or 2000 mg/125 mg) should be considered when: 2

• Antibiotic resistance is likely:

  • Recent antibiotic use (past month)
  • Contact with healthcare environment
  • Prior antibiotic therapy failure
  • High prevalence of resistant bacteria in community 2

• Moderate to severe infections:

  • Frontal or sphenoidal sinusitis
  • History of recurrent infections 2

• Patient factors:

  • Comorbid conditions (diabetes, cardiac, hepatic, or renal disease)
  • Immunocompromised status
  • Age >65 years 2

Important Administration Notes

• Take at the start of a meal to enhance absorption of clavulanate and minimize gastrointestinal intolerance 1
• Two 250 mg/125 mg tablets should NOT be substituted for one 500 mg/125 mg tablet (they contain different amounts of clavulanic acid) 1
• The 12-hour regimen is associated with significantly less diarrhea than 8-hour regimens, especially in pediatric patients 1

Duration of Therapy

• Typical course for respiratory infections: 7-10 days 2
• For sinusitis: 10-14 days or until patient is symptomatically improved for 7 days 2
• For uncomplicated urinary tract infections: 3-7 days 2

Clinical Efficacy Considerations

Recent research suggests that high-dose formulations may not provide additional benefit for all conditions. A 2021 study found no significant difference between standard-dose and high-dose amoxicillin-clavulanate for adults with acute sinusitis 4, so standard dosing may be appropriate for many common infections.