What is the recommended dose of Amoxiclav (amoxicillin/clavulanate) for treating bacterial infections?

Amoxicillin-Clavulanate (Amoxiclav) Dosing

For adults with respiratory tract infections or moderate-to-severe bacterial infections, prescribe amoxicillin-clavulanate 875 mg/125 mg twice daily as the standard dose, or escalate to 2000 mg/125 mg twice daily when antibiotic resistance is likely or infection severity warrants higher dosing. 1, 2, 3

Standard Adult Dosing

• 875 mg/125 mg twice daily is the recommended dose for acute bacterial rhinosinusitis, community-acquired pneumonia, acute exacerbations of chronic bronchitis, and skin/soft tissue infections 2, 3
• For mild-to-moderate infections, 500 mg/125 mg three times daily provides adequate coverage 2
• Animal or human bite infections require 875 mg/125 mg twice daily for 5-7 days 4
• The medication may be taken without regard to meals, though absorption of clavulanate is enhanced when taken at the start of a meal, which also minimizes gastrointestinal intolerance 3

High-Dose Adult Formulations

Use 2000 mg/125 mg twice daily when any of the following risk factors are present 1, 2:

• Recent antibiotic use (within the past 30 days)
• Geographic regions with >10% prevalence of penicillin-nonsusceptible Streptococcus pneumoniae
• Severe infection (frontal or sphenoidal sinusitis, moderate-to-severe pneumonia)
• Age >65 years
• Recent hospitalization or close contact with healthcare environments
• Immunocompromised status or significant comorbidities (diabetes, chronic heart/lung/liver/kidney disease)
• Smoking or household exposure to smoke
• Close contact with daycare facilities
• History of recurrent infections or prior antibiotic therapy failure

This high-dose formulation achieves adequate serum concentrations to eradicate S. pneumoniae with amoxicillin MICs up to 4-8 mg/L 1, 5

Pediatric Dosing

Standard dose: 45 mg/kg/day of amoxicillin component divided twice daily (or 40 mg/kg/day divided three times daily for less severe infections) 1, 2

High-dose: 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses for 6, 1, 2:

• Acute bacterial rhinosinusitis
• Acute otitis media in children who received amoxicillin in the previous 30 days or with otitis-conjunctivitis
• Suspected resistant infections

For children <12 weeks, use 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours 1

Duration of Therapy

• Respiratory tract infections: 7-10 days 1
• Acute bacterial rhinosinusitis (adults): 5-7 days 1
• Acute bacterial rhinosinusitis (children): 10-14 days 2
• Skin and soft tissue infections: 5-7 days after clinical improvement 4
• Uncomplicated urinary tract infections: 3-7 days 1
• Community-acquired pneumonia: 7-10 days, may extend to 14 days based on clinical response 1

Intravenous Dosing

• Moderate-to-severe community-acquired pneumonia: 1.2 g IV every 8 hours 4
• Intra-abdominal infections (non-critically ill, adequate source control): 2 g/0.2 g IV every 8 hours 1, 4
• Pediatric IV dosing: 30 mg/kg three times daily, increase to four times daily in severe infections for patients >3 months 1

Renal Dosing Adjustments

• Patients with glomerular filtration rate <30 mL/min should not receive the 875 mg dose 3
• Dose reduction is generally not required unless renal impairment is severe 3

Critical Dosing Pitfalls to Avoid

• Do not underdose in high-resistance areas—always use high-dose formulations (2000 mg/125 mg twice daily for adults or 90 mg/kg/day for children) when penicillin-resistant S. pneumoniae prevalence exceeds 10% 1
• Avoid macrolides and trimethoprim-sulfamethoxazole as first-line therapy due to high resistance rates 2
• Do not use fluoroquinolones as first-line in non-penicillin-allergic patients despite comparable efficacy, due to higher adverse event rates and need for antimicrobial stewardship 2
• Evaluate clinical response within 48-72 hours of initiating therapy to determine need for alternative management 1
• Complete the full treatment course to prevent treatment failure and resistance development 2

Penicillin-Allergic Patients

For patients with penicillin allergy, use doxycycline 100 mg twice daily or respiratory fluoroquinolones (levofloxacin 750 mg daily or moxifloxacin 400 mg daily) instead 2