Clavulin (Amoxicillin-Clavulanate) Dosing
For adults with respiratory tract infections, the standard dose is 875 mg/125 mg twice daily, but use the high-dose formulation of 2000 mg/125 mg twice daily when antibiotic resistance is likely or for severe infections. 1, 2
Adult Dosing Regimens
Standard Dosing
- 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours for mild to moderate infections 2
- 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for more severe infections and respiratory tract infections 1, 2
High-Dose Regimen (2000 mg/125 mg twice daily)
Use high-dose formulations when any of these risk factors are present: 1
- Recent antibiotic use within the past 4-6 weeks
- Contact with healthcare environment
- Prior antibiotic therapy failure
- High prevalence of resistant bacteria in the community (>10% penicillin-resistant S. pneumoniae)
- Moderate to severe infections (frontal or sphenoidal sinusitis)
- Comorbid conditions (diabetes, chronic heart/lung/liver/kidney disease)
- Immunocompromised status
- Age >65 years
- Smoking or exposure to smokers
The high-dose regimen achieves adequate serum concentrations to eradicate penicillin-resistant Streptococcus pneumoniae with MICs up to 4-8 mg/L, with predicted clinical efficacy of 90-92%. 1
Pediatric Dosing
Standard Dosing (Children ≥12 weeks)
- Less severe infections: 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours 1
- More severe infections: 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours 1, 2
High-Dose Regimen (90 mg/kg/day)
Use 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses for children with: 3
- Age <2 years
- Daycare attendance
- Recent antibiotic use within 30 days
- Incomplete Haemophilus influenzae type b vaccination
- Geographic area with high penicillin-resistant S. pneumoniae prevalence (>10%)
- Moderate to severe illness
- Concurrent purulent otitis media
The high-dose pediatric formulation provides a 14:1 ratio of amoxicillin to clavulanate, which causes less diarrhea than other formulations while maintaining efficacy. 3
Age-Based Oral Suspension Dosing
- Birth to 1 year: 2.5 ml of 125/31 suspension three times daily 1
- 1-6 years: 5 ml of 125/31 suspension three times daily 1
- 7-12 years: 5 ml of 250/62 suspension three times daily 1
- ≥40 kg: Dose according to adult recommendations 2
Neonates and Infants <12 weeks
30 mg/kg/day divided every 12 hours based on the amoxicillin component; use the 125 mg/5 mL oral suspension 2
Duration of Therapy
- Respiratory infections: 7-10 days 1
- Sinusitis (adults): 5-7 days 1
- Sinusitis (children): 10-14 days 1
- Uncomplicated UTIs: 3-7 days 1
- Acute otitis media (children): 10 days 2
- Community-acquired pneumonia: 7-10 days, may extend to 14 days depending on clinical response 1
Critical Dosing Considerations
Evaluate clinical response within 48-72 hours of initiating therapy. 1 If no improvement or worsening occurs after 72 hours, consider switching antibiotics or reevaluating the diagnosis. 1
Common Pitfalls to Avoid
- Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet - they contain the same amount of clavulanic acid (125 mg) but different amounts of amoxicillin 2
- Do not use the 250 mg/125 mg tablet in children <40 kg due to different amoxicillin to clavulanic acid ratios 2
- Avoid underdosing in areas with high penicillin-resistant S. pneumoniae prevalence - always use high-dose formulations 1
- Verify suspension concentration (125/31 vs 250/62) before calculating volume to avoid dosing errors 3
Renal Impairment Adjustments
- GFR <30 mL/min: Do not use 875 mg/125 mg dose 2
- GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours 2
- GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours 2
- Hemodialysis: 500 mg/125 mg or 250 mg/125 mg every 24 hours, with additional dose during and at end of dialysis 2
Administration
Take at the start of a meal to minimize gastrointestinal intolerance and enhance absorption of clavulanate. 2