What is the recommended dosage and treatment plan for amoxicillin (amoxicillin) clavulanate for bacterial infections?

Amoxicillin-Clavulanate Dosage and Treatment Plan for Bacterial Infections

The recommended dosage of amoxicillin-clavulanate for bacterial infections varies by patient age, infection type, and severity, with standard adult dosing being 875/125 mg twice daily or 500/125 mg three times daily for most infections, and pediatric dosing based on weight at 45-90 mg/kg/day of the amoxicillin component. 1, 2

Adult Dosing

• For mild to moderate infections in adults, the standard dose is 500/125 mg every 8 hours or 875/125 mg every 12 hours for 7-10 days 2
• For more severe infections and respiratory tract infections, the dose should be 875/125 mg every 12 hours or 500/125 mg every 8 hours 2
• High-dose therapy (2000/125 mg twice daily) is recommended for areas with high prevalence of resistant pathogens, particularly for respiratory infections 3, 4
• For animal or human bite infections, amoxicillin-clavulanate 875/125 mg twice daily is recommended 1

Pediatric Dosing

• For children ≥3 months, dosing is based on the amoxicillin component: 2
  • For otitis media, sinusitis, lower respiratory tract infections, and more severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
  • For less severe infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
• High-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses) is recommended for children with risk factors for resistant pathogens 5
• For neonates and infants <12 weeks: 30 mg/kg/day divided every 12 hours, based on the amoxicillin component 2
• Children weighing ≥40 kg should receive adult dosing 2

Duration of Therapy

• For adults with uncomplicated acute bacterial rhinosinusitis (ABRS), a 5-7 day course is recommended 1
• For children with ABRS, a longer treatment duration of 10-14 days is recommended 1
• For most respiratory infections, 7-10 days of therapy is typically sufficient 3, 2

Special Populations and Considerations

• Patients with impaired renal function (GFR <30 mL/min) should not receive the 875/125 mg dose 2
• For patients with GFR 10-30 mL/min: 500/125 mg or 250/125 mg every 12 hours, depending on infection severity 2
• For patients with GFR <10 mL/min: 500/125 mg or 250/125 mg every 24 hours 2
• Hemodialysis patients should receive an additional dose both during and at the end of dialysis 2

Clinical Advantages and Considerations

• The twice-daily formulation improves compliance and has fewer gastrointestinal side effects compared to three-times-daily dosing due to reduced total daily clavulanate 6
• The addition of clavulanate extends amoxicillin's spectrum to include beta-lactamase-producing organisms such as H. influenzae, M. catarrhalis, and some S. aureus strains 4, 7
• The maximum daily dose of the amoxicillin component should not exceed 4 grams per day in adults, regardless of patient size 8

Common Pitfalls and Caveats

• Diarrhea is the most common side effect, particularly with higher doses of clavulanate; taking with food may reduce gastrointestinal effects 9, 10
• Two 250/125 mg tablets should not be substituted for one 500/125 mg tablet, as they contain the same amount of clavulanate (125 mg) but different amounts of amoxicillin 2
• The 250/125 mg tablet and 250/62.5 mg chewable tablet are not interchangeable as they contain different amounts of clavulanate 2
• For empiric treatment of ABRS, amoxicillin-clavulanate is preferred over amoxicillin alone in both adults (weak recommendation) and children (strong recommendation) 1
• Routine coverage for S. aureus (including MRSA) during initial empiric therapy of ABRS is not recommended 1