What is the dosage and treatment regimen for Amoxicillin (Amoxicillin) Potassium Clavulanate (Clavulanic acid) syrup for bacterial infections?

Amoxicillin-Potassium Clavulanate Syrup Dosing for Bacterial Infections

For bacterial infections, amoxicillin-potassium clavulanate syrup should be dosed at 25 mg/kg/day of the amoxicillin component in 2 divided doses for mild to moderate infections in children, and 45 mg/kg/day in 2 divided doses for severe infections. 1, 2

Adult Dosing

• For mild to moderate infections in adults, the standard dose is 500 mg amoxicillin/125 mg clavulanate every 8 hours or 875 mg amoxicillin/125 mg clavulanate every 12 hours for 7-10 days 1, 3
• For severe infections in adults, including lower respiratory tract infections, the recommended dose is 875 mg amoxicillin/125 mg clavulanate every 12 hours or 500 mg amoxicillin/125 mg clavulanate every 8 hours 3
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 3

Pediatric Dosing

• For children with mild to moderate infections, the standard dose is 25 mg/kg/day of the amoxicillin component in 2 divided doses 1, 2
• For severe infections or those caused by less susceptible organisms, the dose should be increased to 45 mg/kg/day of the amoxicillin component in 2 divided doses 1, 4
• For children under 3 months of age, the maximum recommended dose is 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 3
• For children with risk factors (daycare attendance, recent antibiotic use, high prevalence of resistant bacteria), high-dose therapy of 80-90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses is recommended 2, 4

Duration of Treatment

• For most bacterial infections, treatment should continue for 7-10 days 3
• For Streptococcus pyogenes infections, a minimum of 10 days of treatment is recommended to prevent acute rheumatic fever 3
• For respiratory infections, treatment duration is typically 5-7 days for adults and 10-14 days for children 2

Administration Guidelines

• To minimize gastrointestinal intolerance, amoxicillin-clavulanate should be taken at the start of a meal 3
• After reconstitution, the suspension should be shaken well before each use 3
• The reconstituted suspension can be administered directly or mixed with formula, milk, fruit juice, water, or cold drinks 3
• Any unused portion of the reconstituted suspension must be discarded after 14 days 3

Specific Indications

• For upper respiratory tract infections (ear, nose, throat): Standard dosing as above 3
• For skin and soft tissue infections: Standard dosing as above 1
• For lower respiratory tract infections: Higher dosing regimen recommended 3
• For animal or human bites: 875 mg/125 mg twice daily for adults 2

Important Clinical Considerations

• The 14:1 ratio of amoxicillin to clavulanate in high-dose formulations is less likely to cause diarrhea than other preparations 2, 4
• Common adverse effects include diarrhea, nausea, vomiting, and rash 4
• Patients with severe renal impairment (GFR less than 30 mL/min) should NOT receive the 875 mg dose 3
• For patients with documented beta-lactam allergy, alternative antibiotics should be considered 1

Preparation of Suspension

• Tap bottle until all powder flows freely 3
• Add approximately 1/3 of the required water to powder, shake vigorously, then add remaining water and shake again 3
• For 125 mg/5 mL suspension: Add 70 mL water to 80 mL bottle, 87 mL to 100 mL bottle, or 130 mL to 150 mL bottle 3
• For 250 mg/5 mL suspension: Add 56 mL water to 80 mL bottle, 70 mL to 100 mL bottle, or 105 mL to 150 mL bottle 3
• Refrigeration is preferable but not required 3