What is the appropriate dosing regimen of amoxicillin‑clavulanate for adults and children, and how should the dose be adjusted in patients with impaired renal function?

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Last updated: February 18, 2026 • View editorial policy

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Amoxicillin-Clavulanate Dosing Guidelines

Adult Dosing

For adults with respiratory tract infections and normal renal function, prescribe amoxicillin-clavulanate 875 mg/125 mg twice daily for 5–7 days as the standard regimen. 1

Standard-Dose Regimen (Low-Risk Patients)

  • 875 mg/125 mg twice daily for 5–7 days achieves clinical cure rates of 88–93% in uncomplicated respiratory infections. 1, 2
  • Alternative: 500 mg/125 mg three times daily for 7–10 days, though twice-daily dosing improves adherence. 1, 3
  • A 5–7 day course is as effective as 10 days for acute bacterial rhinosinusitis and produces fewer adverse effects. 1

High-Dose Regimen (Patients with Resistance Risk Factors)

  • 2000 mg/125 mg twice daily for 5–7 days when any of these factors are present: 1, 4

    • Recent antibiotic use (past 4–6 weeks)
    • Age > 65 years
    • Moderate-to-severe infection
    • Comorbidities (diabetes, chronic cardiac/pulmonary/renal/hepatic disease)
    • Immunocompromised status
    • Smoking or exposure to smokers
    • Daycare contact or healthcare environment exposure
    • Community prevalence of penicillin-resistant S. pneumoniae > 10%
    • Frontal or sphenoidal sinusitis
    • History of recurrent infections or prior treatment failure

  • High-dose therapy achieves 90–92% predicted clinical efficacy versus 83–88% for standard dosing in resistance-risk populations. 1, 4

  • This regimen eradicates S. pneumoniae strains with amoxicillin MICs up to 4–8 mg/L. 4

Intravenous Dosing (Severe Infections)

  • 1.2 g (1000 mg amoxicillin/200 mg clavulanate) every 6–8 hours for hospitalized patients with severe pneumonia or intra-abdominal infections. 4, 5
  • Switch to oral therapy (625 mg three times daily or 875 mg twice daily) as soon as clinically appropriate. 1, 4

Pediatric Dosing (≥ 3 Months, < 40 kg)

For children with respiratory infections, prescribe high-dose amoxicillin-clavulanate 90 mg/kg/day (amoxicillin component) + 6.4 mg/kg/day (clavulanate) divided twice daily for 10–14 days as first-line therapy. 1, 4

High-Dose Regimen (First-Line for Most Infections)

  • 90 mg/kg/day amoxicillin + 6.4 mg/kg/day clavulanate divided into 2 doses daily for 10–14 days. 1, 4
  • Maximum daily dose: 4000 mg amoxicillin. 4, 5
  • This 14:1 ratio formulation causes less diarrhea than older preparations. 1

Indications for High-Dose Pediatric Therapy

Use high-dose regimen when any of these factors are present: 1, 4

  • Age < 2 years
  • Daycare attendance
  • Recent antibiotic use (past 30 days)
  • Incomplete Haemophilus influenzae type b vaccination
  • Regional penicillin-resistant S. pneumoniae prevalence > 10%
  • Moderate-to-severe illness
  • Concurrent purulent otitis media or conjunctivitis
  • Pneumonia not responding to amoxicillin alone

Standard-Dose Regimen (Uncomplicated Cases Only)

  • 45 mg/kg/day amoxicillin + 6.4 mg/kg/day clavulanate divided twice daily for 10–14 days. 1, 4
  • Use only for mild, uncomplicated infections in children without risk factors. 1

Intravenous Pediatric Dosing

  • 30 mg/kg (amoxicillin component) every 8 hours for moderate infections. 4, 5
  • 200 mg/kg/day divided every 6 hours for severe infections or when undrained abscesses are suspected. 5
  • Administer as IV infusion over 15–30 minutes. 5

Patients ≥ 40 kg

  • Dose as adults (875 mg/125 mg twice daily or 2000 mg/125 mg twice daily), not using pediatric weight-based calculations. 1

Renal Impairment Dosing Adjustments

In patients with renal impairment, reduce dosing frequency or total daily dose based on creatinine clearance to prevent drug accumulation. 4, 6

Adults with Renal Dysfunction

  • CrCl 10–30 mL/min: Reduce frequency to every 12 hours OR decrease dose by 50%. 4
  • CrCl < 10 mL/min: Reduce frequency to every 24 hours OR decrease dose by 75%. 4
  • Hemodialysis: Administer supplemental dose after each dialysis session. 4, 7
  • Amoxicillin half-life increases from 71 minutes (normal renal function) to 16 hours in anephric patients. 6

Pediatric Renal Impairment

  • Apply proportional dose reductions based on estimated creatinine clearance, mirroring adult adjustments. 4
  • Specific pediatric renal dosing data are limited; consult infectious disease specialist for severe impairment. 4

Patients on Renal Replacement Therapy

  • In critically ill patients receiving continuous RRT, consider 2.2 g every 6–8 hours with therapeutic drug monitoring, as RRT significantly increases clearance even with normal native kidney function. 7

Clinical Reassessment and Treatment Failure

Adults

  • Reassess at 3–5 days: If no improvement, escalate to high-dose amoxicillin-clavulanate (2000 mg/125 mg twice daily) or switch to a respiratory fluoroquinolone. 1
  • Reassess at 7 days: Persistent or worsening symptoms require diagnostic reconsideration, imaging (CT scan), and possible ENT referral. 1, 4

Children

  • Reassess at 72 hours: Lack of improvement or clinical worsening warrants escalation to high-dose regimen (90 mg/kg/day). 1, 4
  • Expect clinical improvement within 48–72 hours; if absent, reevaluate diagnosis and consider alternative pathogens. 5

Common Pitfalls and Caveats

  • Avoid antibiotics for symptom duration < 10 days unless severe features are present (fever ≥ 39°C with purulent nasal discharge for ≥ 3 consecutive days); 98–99.5% of acute rhinosinusitis cases are viral. 1
  • 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 community penicillin-resistant S. pneumoniae prevalence exceeds 10%. 1, 4
  • Minimum treatment duration: ≥ 5 days for adults and ≥ 10 days for children to reduce relapse risk. 1
  • Gastrointestinal adverse events occur in 15–40% of patients but rarely require discontinuation. 4
  • Verify weight-based calculations in pediatric patients to prevent dosing errors. 5
  • Do not use for MRSA coverage: Amoxicillin-clavulanate covers methicillin-sensitive S. aureus only; routine MRSA coverage is not recommended for initial empiric therapy of acute bacterial rhinosinusitis. 1

Adjunctive Therapies

  • Intranasal corticosteroids (mometasone, fluticasone, budesonide) twice daily reduce mucosal inflammation and accelerate symptom resolution. 1
  • Saline nasal irrigation 2–3 times daily enhances mucus clearance and provides symptomatic relief. 1
  • Analgesics (acetaminophen or ibuprofen) for pain and fever control. 1

References

1
Guideline

Amoxicilina-Ácido Clavulánico Dosing Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Amoxicillin-Clavulanate Dosage and Administration

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Pediatric Dosing for Injectable Antibiotics

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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