Co-Amoxiclav Therapeutic Dosing
For adults with respiratory tract infections, co-amoxiclav 875 mg/125 mg twice daily is the recommended therapeutic dose, while more severe infections may require 2000 mg/125 mg twice daily. 1, 2, 3
Adult Dosing Regimens
Standard Dosing
- 500 mg/125 mg every 8 hours or 875 mg/125 mg every 12 hours for mild-to-moderate infections 2, 3
- The 875/125 mg twice daily formulation is specifically recommended for respiratory infections including acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 2
- For more severe infections and respiratory tract infections, use 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 3
High-Dose Formulations
- 2000 mg/125 mg twice daily (pharmacokinetically enhanced formulation) is recommended when antibiotic resistance is likely, including recent antibiotic use, healthcare contact, prior treatment failure, or high community prevalence of resistant bacteria 1
- This high-dose regimen achieves adequate serum concentrations to eradicate penicillin-resistant Streptococcus pneumoniae with amoxicillin MICs up to 4-8 mg/L 4, 5
- Consider higher doses for moderate-to-severe infections (frontal/sphenoidal sinusitis), patients with comorbidities, immunocompromised status, or age >65 years 1
Duration of Therapy
- 5-7 days for uncomplicated acute bacterial rhinosinusitis in adults 4, 2
- 7-10 days for respiratory infections generally 1
- 10-14 days for sinusitis or until symptomatically improved for 7 days 1
- 3-7 days for uncomplicated urinary tract infections 1
Pediatric Dosing
Standard Pediatric Regimens
- 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours for more severe infections in children ≥12 weeks 1
- 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours for less severe infections in children ≥12 weeks 1
- Children weighing ≥40 kg should be dosed according to adult recommendations 3
High-Dose Pediatric Formulation
- 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses for acute bacterial rhinosinusitis and resistant infections 4, 1
- This high-dose regimen is recommended for children with recent antimicrobial use (past 4-6 weeks) or moderate disease 4
- 10-14 days duration is recommended for children with acute bacterial rhinosinusitis (longer than adults) 4
Critical Dosing Considerations
Formulation Warnings
- Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet - this results in excessive clavulanate dosing (250 mg vs 125 mg) 2, 3
- Both 250 mg/125 mg and 500 mg/125 mg tablets contain the same amount of clavulanic acid (125 mg), making them non-interchangeable 3
- The 250 mg/125 mg tablet should not be used in pediatric patients until they weigh at least 40 kg 3
Administration
- Administer at the start of a meal to enhance clavulanate absorption and minimize gastrointestinal intolerance 3
- May be taken without regard to meals, though absorption is optimized with food 3
Renal Impairment Adjustments
- GFR <30 mL/min: Do not use 875 mg/125 mg formulation 3
- GFR 10-30 mL/min: Use 500 mg/125 mg or 250 mg/125 mg every 12 hours 3
- GFR <10 mL/min: Use 500 mg/125 mg or 250 mg/125 mg every 24 hours 3
- Hemodialysis patients: 500 mg/125 mg or 250 mg/125 mg every 24 hours, with additional dose during and at end of dialysis 3
Hepatic Impairment
- Dose with caution and monitor hepatic function at regular intervals 3
Common Pitfalls
- Avoid underdosing in areas with high penicillin-resistant S. pneumoniae prevalence - use high-dose formulations (2000 mg/125 mg twice daily for adults or 90 mg/kg/day for children) 4, 1
- Evaluate clinical response within 48-72 hours of initiating therapy to determine need for alternative management 4, 1
- Complete the full course regardless of clinical improvement to prevent treatment failure and resistance development 2
- For severe infections with potential toxin-producing organisms, co-amoxiclav alone may be insufficient 4
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