Suppressive Dose of Amoxicillin-Clavulanate (Clavulin)
For suppressive therapy with amoxicillin-clavulanate, the recommended dose is 250/125 mg once daily for adults, which can be maintained for up to 3 months. 1
Adult Dosing for Suppressive Therapy
- Standard suppressive dose: 250 mg amoxicillin with 125 mg clavulanic acid once daily 1
- Duration of suppressive therapy: typically up to 3 months 1
- This lower dose is appropriate for suppression after completing a full treatment course of the infection 2, 1
Comparison to Treatment Doses
The suppressive dose is significantly lower than treatment doses, which typically include:
- Standard treatment dose for adults: 500/125 mg every 12 hours or 250/125 mg every 8 hours 2
- High-dose treatment for severe infections: 875/125 mg every 12 hours or 500/125 mg every 8 hours 2
- Maximum treatment dose for resistant organisms: 2000/125 mg twice daily (available as Augmentin XR in the USA) 3
Clinical Context for Suppressive Therapy
- Suppressive therapy is primarily used after successfully treating an acute infection to prevent recurrence 1
- Particularly useful in patients with recurrent urinary tract infections, including those with resistant organisms 1, 4
- Has shown effectiveness in preventing recurrences in transplant recipients and patients with chronic conditions 1
Important Considerations and Precautions
- Suppressive therapy should only be initiated after the acute infection has been adequately treated with appropriate doses 1
- Monitor for gastrointestinal side effects, which are the most common adverse events with amoxicillin-clavulanate 3
- Taking the medication with food can minimize gastrointestinal intolerance 2
- Long-term use may potentially select for resistant organisms, so periodic reassessment is recommended 5
Pediatric Considerations
- For children requiring suppressive therapy, the dose should be calculated based on weight 6
- Typical pediatric suppressive dose: 20 mg/kg once daily 4
- This follows a full treatment course at standard doses (45 mg/kg/day) or high doses (90 mg/kg/day) depending on infection severity 6
Common Pitfalls to Avoid
- Initiating suppressive therapy before completely resolving the acute infection 1
- Using treatment doses for suppression, which may increase side effects without additional benefit 3
- Failing to reassess the need for continued suppression periodically 5
- Not considering local resistance patterns when selecting antimicrobial suppression 5
While there is limited high-quality evidence specifically addressing suppressive dosing of amoxicillin-clavulanate, clinical experience supports the use of lower doses for prevention after successful treatment of the acute infection 1, 4.