Dosage of Amoxicillin/Clavulanate for Tonsillitis
For tonsillitis, the recommended dose of amoxicillin/clavulanate (Augmentin) is 500 mg twice daily for adults and 40 mg/kg/day divided into three doses for children, with a treatment duration of 10 days. 1
Adult Dosing
- Standard dose: 500 mg twice daily for 10 days 1
- For severe infections or areas with high prevalence of resistant pathogens: High-dose amoxicillin/clavulanate at 2000/125 mg twice daily (Augmentin XR formulation) may be considered 2
- The complete 10-day course should be taken even if symptoms improve before completion 1
Pediatric Dosing
- Standard dose: 40 mg/kg/day of the amoxicillin component divided into three equal doses for 10 days 1
- For areas with high resistance or recurrent infections: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate divided into two doses (Augmentin ES-600 formulation) 2
- Children should complete the full 10-day course even if symptoms resolve earlier 1
Clinical Considerations
- Amoxicillin/clavulanate is particularly useful for recurrent streptococcal tonsillitis or when beta-lactamase producing bacteria are suspected 3
- Studies show amoxicillin/clavulanate has superior efficacy compared to penicillin V in eradicating Group A beta-hemolytic streptococci in recurrent tonsillitis (100% vs 70% eradication) 3
- Twice-daily formulations have shown equivalent efficacy to three-times-daily regimens with potentially better compliance (82.8% vs 73.3%) 4
Formulation Considerations
- It's important to note that two tablets of 250 mg amoxicillin/clavulanate are NOT equivalent to one tablet of 500 mg, as both contain 125 mg of clavulanic acid 1
- The pharmacokinetically enhanced formulations (Augmentin XR for adults and Augmentin ES-600 for children) are specifically designed to overcome resistant pathogens 2
Alternative Options for Penicillin-Allergic Patients
- Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1
- Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days, though resistance should be considered 1
- Clarithromycin: 7.5 mg/kg twice daily (maximum 250 mg per dose) for 10 days 1
Monitoring and Follow-up
- Patients are considered non-contagious after 24 hours of antibiotic therapy 1
- Clinical improvement should be evident within 48-72 hours of starting treatment 5
- If symptoms worsen or don't improve after 72 hours, consider alternative antimicrobial therapy or reevaluation 5
Common Pitfalls
- Underdosing or shortened treatment duration may lead to treatment failure and recurrent infections 3
- Failure to complete the full 10-day course increases the risk of complications such as rheumatic fever 1
- Using clarithromycin in areas with high clarithromycin resistance may result in treatment failure (only 14-19% eradication of resistant strains) 6