Clavam (Amoxicillin-Clavulanate) Three Times Daily Dosing by Age
Clavam can be started as a three times daily (TDS) dose from birth onwards, with specific weight-based dosing beginning at ≥12 weeks of age for most infections. 1
Age-Specific TDS Dosing Guidelines
Infants and Young Children (Birth to 1 Year)
- Standard dosing: 0.266 ml/kg of 125/31 suspension three times daily from birth 1
- Alternative fixed dosing: 2.5 ml of 125/31 suspension three times daily for children birth to 1 year 1
- For children ≥12 weeks with less severe infections: 20 mg/kg/day divided every 8 hours (TDS) 1
- For children ≥12 weeks with more severe infections: 40 mg/kg/day divided every 8 hours (TDS) 1
Children 1-6 Years
- Standard dosing: 5 ml of 125/31 suspension three times daily 1
Children 7-12 Years
- Standard dosing: 5 ml of 250/62 suspension three times daily 1
Children 12-18 Years
- Standard dosing: 1 tablet (250/125 mg) three times daily 1
High-Dose TDS Regimen for Resistant Infections
For severe infections or suspected resistant bacteria, a high-dose formulation providing 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate can be given in two divided doses (not TDS), which is preferred over TDS dosing for resistant pathogens. 1 This formulation was specifically developed to provide better coverage against penicillin-resistant Streptococcus pneumoniae. 2
Important Clinical Considerations
When to Use TDS vs BID Dosing
- TDS (three times daily) dosing is the traditional regimen and remains appropriate for standard infections 1
- BID (twice daily) dosing has been shown to be equally effective as TDS dosing with improved compliance and potentially fewer gastrointestinal side effects due to lower total daily clavulanate exposure 3, 4
- Clinical trials demonstrate that once or twice daily amoxicillin-clavulanate produces comparable clinical cure rates, recurrence rates, and compliance compared to three times daily dosing 3
Common Pitfalls to Avoid
- Do not extrapolate term infant dosing to premature infants due to immature renal function and risk of drug accumulation 5
- Diarrhea occurs more frequently with TDS dosing (22.6% incidence) compared to BID dosing, particularly in younger children, though most cases are non-serious and reversible 6
- Evaluate clinical response within 48-72 hours of initiating therapy to determine if alternative management is needed 1
Severe Infections Requiring Dose Adjustment
For severe infections in children >3 months, increase dosing frequency to four times daily when using intravenous formulations (30 mg/kg four times daily IV). 1 However, for oral TDS dosing, simply increase the total daily dose rather than frequency (e.g., 40 mg/kg/day instead of 20 mg/kg/day, still divided TDS). 1