Amoxicillin-Clavulanate 625 mg Dosing and Duration
For adults with respiratory tract infections, amoxicillin-clavulanate 625 mg (500 mg amoxicillin/125 mg clavulanic acid) should be administered three times daily for 5-14 days depending on the specific infection type. 1
Standard Adult Dosing Regimens
The FDA-approved dosing for amoxicillin-clavulanate 625 mg varies by infection severity 1:
- Mild to moderate infections: One 625 mg tablet every 8 hours 1
- Respiratory tract infections and more severe infections: One 625 mg tablet every 8 hours, or alternatively 875/125 mg every 12 hours 1
- Administration: May be taken without regard to meals, though absorption of clavulanate is enhanced when taken at the start of a meal 1
Duration by Infection Type
Acute Bacterial Rhinosinusitis
- Standard duration: 5-7 days for uncomplicated cases 2
- With risk factors (recent antibiotic use within 4-6 weeks, treatment failure, moderate disease): 625 mg three times daily for 5-7 days 3, 2
- Note: Shorter 5-7 day courses are as effective as 10-day regimens in most cases 2
Chronic Rhinosinusitis
- Standard duration: 14 days (or up to 3 weeks in comparative trials) 3
- Dosing: 625 mg three times daily 3
Bronchiectasis Exacerbations
Community-Acquired Pneumonia (Pediatric Context)
- Duration: 10 days for beta-lactam treatment of pneumococcal pneumonia 3
- Pediatric dosing: 80 mg/kg/day of amoxicillin component in children below 5 years when indicated 3
Acute Bronchiolitis/Bronchitis (Pediatric)
- Duration: 5-8 days when antibiotics are indicated 3
- Note: First-line antibiotics generally not indicated unless high fever >38.5°C persisting >3 days 3
Key Clinical Considerations
Risk factors requiring amoxicillin-clavulanate over amoxicillin alone 3, 2:
- Recent antibiotic use within past 4-6 weeks
- Previous treatment failure
- Moderate to severe disease
- Age >65 years
- Immunocompromised status
- High local prevalence of resistant S. pneumoniae
- Smokers or exposure to smoke
- Comorbidities present
Common pitfall: Do not substitute two 250/125 mg tablets for one 500/125 mg tablet, as both contain the same amount of clavulanic acid (125 mg), which would result in clavulanate overdosing 1
Renal adjustment required 1:
- GFR 10-30 mL/min: 625 mg every 12 hours
- GFR <10 mL/min: 625 mg every 24 hours
- Hemodialysis: 625 mg every 24 hours plus additional dose during and after dialysis
Tolerability
The most common adverse effect is diarrhea, which can be minimized by taking the medication at the start of meals 1, 4. The combination is generally well tolerated with gastrointestinal disturbances being mild in most cases 5, 4.