What is the recommended dosing of Clavulin (amoxicillin-clavulanate) for a patient with strep throat?

Clavulin Dosing for Strep Throat

Clavulin (amoxicillin-clavulanate) is NOT the first-line antibiotic for uncomplicated strep throat—use plain amoxicillin or penicillin V instead. 1, 2

When to Use Clavulin for Strep Throat

Clavulin is reserved for specific scenarios, not routine strep pharyngitis:

• Chronic streptococcal carriers with recurrent symptomatic episodes: This is the primary indication where the clavulanate component helps eradicate bacteria that are difficult to eliminate from the pharynx 1, 2
• Suspected polymicrobial infection: When there's concern for mixed bacterial pathogens beyond Group A Streptococcus 1

Dosing Regimen When Clavulin IS Indicated

Adults

• 500 mg (amoxicillin component) twice daily for 10 days 1, 2
• Alternative: 500 mg/125 mg three times daily for 10 days 1
• The full 10-day course is mandatory to prevent acute rheumatic fever, regardless of symptom improvement 1, 2

Pediatric Patients

• 40 mg/kg/day of the amoxicillin component divided into three doses for 10 days (maximum 2000 mg amoxicillin per day) 1, 2
• This dosing applies to children aged 12 weeks and older 3

First-Line Treatment for Uncomplicated Strep Throat

Use these instead of Clavulin for standard acute streptococcal pharyngitis:

Adults

• Amoxicillin 1000 mg once daily for 10 days (preferred for compliance) 1, 2
• Alternative: Penicillin V 500 mg twice daily for 10 days 1, 2

Children

• Amoxicillin 50 mg/kg once daily (maximum 1000 mg) for 10 days 2
• Alternative: 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 2

Critical Dosing Pitfalls to Avoid

• Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet: Both contain 125 mg clavulanate, resulting in excessive clavulanate exposure and significantly increased gastrointestinal side effects 1, 3
• Do not shorten the 10-day course: Completing the full duration is essential to prevent acute rheumatic fever, even if symptoms resolve earlier 1, 2
• Patients become non-contagious after 24 hours of antibiotic therapy, but treatment must continue for the full 10 days 2

Penicillin-Allergic Patients

If the patient cannot tolerate penicillins, use these alternatives instead of Clavulin:

• Cephalexin: First-generation cephalosporin (safe in most penicillin-allergic patients without anaphylaxis history) 1
• Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 2
• Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days, though resistance is a concern 2
• Clarithromycin: 7.5 mg/kg twice daily (maximum 250 mg per dose) for 10 days 2

Why Amoxicillin Alone is Preferred Over Clavulin

• Narrow spectrum: Reduces unnecessary antibiotic exposure and resistance development 1
• Lower cost: Amoxicillin is significantly less expensive 1
• Fewer adverse effects: The clavulanate component increases gastrointestinal side effects (diarrhea occurs in approximately 9% of patients on Clavulin) 1
• Equal efficacy: Plain amoxicillin achieves the same clinical and bacteriologic cure rates for uncomplicated Group A streptococcal pharyngitis 1, 2