What is the typical dosage and treatment regimen for Amoxicillin (Amox)/Clavulanate (Clav) for bacterial infections?

Amoxicillin-Clavulanate Dosing and Treatment Regimens

For adults with bacterial infections, amoxicillin-clavulanate 875/125 mg twice daily is the preferred regimen for most indications including skin/soft tissue infections, respiratory tract infections, and bite wounds, with treatment duration typically 7-10 days. 1, 2, 3

Adult Dosing Regimens

Standard Dosing

• 875/125 mg twice daily is the preferred formulation for most bacterial infections, including:

  • Skin and soft tissue infections 1, 2
  • Respiratory tract infections (acute bacterial rhinosinusitis, community-acquired pneumonia, acute exacerbations of chronic bronchitis) 4
  • Animal or human bite wounds 1, 2
  • This regimen causes significantly less diarrhea compared to three-times-daily dosing 3, 5

• 500/125 mg three times daily is an alternative for mild-to-moderate infections 4, 3

  • However, the twice-daily 875 mg formulation is superior due to better compliance and reduced gastrointestinal side effects 5

Critical Dosing Caveat

• Never substitute two 250 mg tablets for one 500 mg tablet - this results in excessive clavulanate dosing and increased adverse effects 4
• The 250/125 mg and 250/62.5 mg formulations are not interchangeable due to different clavulanate ratios 3

Treatment Duration

• 7-10 days for most skin/soft tissue infections and bite wounds 1, 2
• 5-7 days for uncomplicated acute bacterial rhinosinusitis 4
• 10 days for acute otitis media in children 3
• 14 days for chronic rhinosinusitis 1

Pediatric Dosing

Age-Based Recommendations

Neonates and infants < 12 weeks:

• 30 mg/kg/day (amoxicillin component) divided every 12 hours 3
• Use 125/31.25 mg per 5 mL suspension (200/28.5 mg formulation has limited experience in this age group) 3

Children ≥ 12 weeks:

• For otitis media, sinusitis, lower respiratory tract infections, and severe infections:

  • 45 mg/kg/day every 12 hours (using 200/28.5 or 400/57 mg per 5 mL suspension) 3
  • OR 40 mg/kg/day every 8 hours (using 125/31.25 or 250/62.5 mg per 5 mL suspension) 3
  • The every-12-hour regimen is preferred due to significantly less diarrhea 3, 5

• For less severe infections:

  • 25 mg/kg/day every 12 hours 3
  • OR 20 mg/kg/day every 8 hours 3

Children weighing ≥ 40 kg:

• Dose as adults: 875/125 mg twice daily or 500/125 mg three times daily 3

High-Dose Formulation for Resistant Pathogens

• 90/6.4 mg/kg/day in two divided doses (Augmentin ES-600) for persistent or recurrent acute otitis media with risk factors for beta-lactamase-producing strains or penicillin-resistant S. pneumoniae 6, 7

Specific Clinical Scenarios

Chronic Rhinosinusitis

• 625 mg three times daily for 14 days showed comparable efficacy to other antibiotics 1
• 875/125 mg twice daily for 14 days demonstrated faster symptom improvement and lower relapse rates compared to cefuroxime 1

Bite Wounds (Animal or Human)

• 875/125 mg twice daily provides coverage for Pasteurella multocida, staphylococci, streptococci, and anaerobes 1
• Some gram-negative rods may be resistant; does not cover MRSA 1

Impetigo and Skin Infections

• 875/125 mg twice daily for 7 days 1
• Alternative: 500 mg three times daily 1

Bacterial Prophylaxis in Immunodeficiency

• 10-20 mg/kg daily or twice daily (children) 1
• 500-1,000 mg daily or twice daily (adults) 1
• Consider adding clavulanate if standard amoxicillin prophylaxis fails 1

Administration Guidelines

• Take with food to minimize gastrointestinal side effects 1
• Complete the full course even if symptoms improve to prevent treatment failure and resistance 4
• Monitor hepatic function in patients with hepatic impairment 3

Common Pitfalls to Avoid

1. Do not use for MRSA infections - amoxicillin-clavulanate has no activity against methicillin-resistant Staphylococcus aureus 1

2. Avoid in phenylketonuric patients - the 200 mg and 400 mg suspensions contain aspartame 3

3. Do not use for simple streptococcal pharyngitis - penicillin V or amoxicillin alone are preferred first-line agents due to narrow spectrum and lower cost 4

   • Reserve amoxicillin-clavulanate for chronic streptococcal carriers with recurrent symptomatic episodes (500 mg twice daily for 10 days) 4

4. Recognize geographic resistance patterns - in areas with high prevalence of penicillin-resistant S. pneumoniae, higher doses may be needed 6, 8

5. Be cautious with empirical use for UTIs - rising ESBL prevalence limits utility; consider alternative agents or combination therapy for ESBL-producing organisms 8