What is the recommended dose and administration guidelines for Co-amoxiclav (amoxicillin/clavulanic acid) intravenous (IV) administration?

Co-amoxiclav IV Administration Guidelines

For most adult infections requiring IV therapy, administer co-amoxiclav 1.2 g (1000 mg amoxicillin/200 mg clavulanic acid) intravenously every 8 hours (three times daily). 1, 2

Standard Adult IV Dosing

• The standard IV dose is 1.2 g (1000 mg amoxicillin/200 mg clavulanic acid) administered three times daily for most infections. 1, 2
• For severe community-acquired pneumonia requiring initial parenteral therapy, administer 1.2 g IV three times daily, with switch to oral therapy (625 mg three times daily) after clinical stabilization, typically by day 3. 3
• For COPD exacerbations requiring hospitalization, co-amoxiclav is recommended with IV-to-oral switch by day 3 if the patient is clinically stable. 1

Specific Clinical Scenarios

Severe Acute Respiratory Syndrome (SARS)

• Administer 1.2 g IV three times daily as part of empiric therapy for severe community-acquired pneumonia when SARS is suspected. 1

Necrotizing Soft Tissue Infections

• For polymicrobial necrotizing fasciitis, use piperacillin-tazobactam or a carbapenem rather than co-amoxiclav as broader coverage is required. 1

Surgical Site Infections

• For surgical site infections involving intestinal or genitourinary tract, piperacillin-tazobactam 3.375 g every 6 hours or 4.5 g every 8 hours IV is preferred over co-amoxiclav. 1

Pediatric IV Dosing

• For neonates and infants, specific weight-based dosing is not provided in standard guidelines for co-amoxiclav IV; alternative agents like ampicillin or piperacillin-tazobactam are typically used. 1
• For children requiring IV therapy, the amoxicillin component should be dosed at 80-90 mg/kg/day divided into appropriate intervals, though specific IV formulation dosing is not standardized in pediatric guidelines. 2

Administration Technique

• Infuse IV co-amoxiclav over 30-40 minutes to reduce the risk of adverse reactions. 3
• Do not administer as IV push or rapid bolus. 3

Duration of IV Therapy

• Switch from IV to oral therapy should occur by day 3 if the patient is clinically stable, with fever resolution and ability to tolerate oral intake. 1, 3
• Total treatment duration (IV plus oral) is typically 7-14 days depending on infection severity and site. 1, 2
• For acute bacterial rhinosinusitis in adults, total duration is 5-7 days; in children, 10-14 days. 1, 2

Common Pitfalls to Avoid

• Do not use co-amoxiclav for empiric coverage of MRSA—it has no activity against methicillin-resistant Staphylococcus aureus and vancomycin or linezolid must be added if MRSA is suspected. 1
• Do not use co-amoxiclav as monotherapy for carbapenem-resistant organisms—newer agents like ceftazidime-avibactam are required. 1
• Do not continue IV therapy beyond 3 days if the patient can tolerate oral medication and is clinically improving, as this increases costs without improving outcomes. 1, 3
• Do not use co-amoxiclav for Pseudomonas aeruginosa coverage—ciprofloxacin or antipseudomonal beta-lactams are required. 1

Contraindications and Precautions

• Do not administer to patients with documented penicillin allergy—use alternative agents such as respiratory fluoroquinolones (levofloxacin, moxifloxacin) or clindamycin-based regimens. 2
• Adjust dosing in renal impairment, though specific IV dose adjustments are not detailed in the provided guidelines. 3