Amoxicillin-Clavulanate

C. diff Risk

Medium

Oral Bioavailability

Excellent

Approximate Cost

$2/day

Dosing

General Pediatric

Dosing based on amoxicillin component:

General Dosing:
Infants 1-3 months: 30 mg/kg/24h PO divided q12h
(dosing is based on amoxicillin component - use 25 mg/mL formulation, 4:1 ratio)

Infants and children 3 months and older and less than 35-40 kg: 25-45 mg/kg/24h PO divided q8-12h (use the 80 mg/mL formulation only, 7:1 ratio)

Children 35-40 kg and above: 250-500 mg PO q8h (using 500 mg tablets only, 4:1 ratio)

Otitis Media: (infants and children 3 months and older) 75-90 mg/kg/24h PO divided q12h
(dosed as 45 mg/kg/24h of amoxicillin PLUS 30-45 mg/kg/24h of amoxicillin clavulanate)
OR 45-60 mg/kg/24h PO divided q8h
Children 35 kg and above: 500 mg PO q8h (using 500 mg tablets only)

Community-Acquired Pneumonia (CAP): (infants and children 3 months and older) 40-90* mg/kg/24h PO divided q8h
(if using 90 mg/kg/24h then dose as 45 mg/kg/24h of amoxicillin PLUS 45 mg/kg/24h of amoxicillin and clavulanate)
*use higher dose if patient has any of the following risk factors for resistant Streptococcus pneumoniae :
Unimmunized or incompletely immunized, daycare attendance, use of antibiotics in the preceding 3 months, failure of initial therapy

Polymicrobial Infections: Infants 3 months and older and children less than 35-40 kg: 40-50 mg/kg/24h PO divided q 8 h (using the 80 mg/mL suspension) (7:1 ratio)

Children 35-40 kg and above: 500 mg PO q8h (using 500 mg tablets only) (4:1 ratio)

Note: Using a product with incorrect amoxicillin-clavulanate could result in sub-therapeutic clavulanate concentrations or severe diarrhea. If possible, limit clavulanate to 6.4 mg/kg/24h to reduce GI side effects. Based upon usual dosing in pediatric patients less than 40 kg, typical 7:1 regimens provide 3.4-6.4 mg/kg/24h of clavulanate and 4:1 regimens provide 5-10 mg/kg/24h

Adult

500 mg PO q8h

Neonatal

30 mg/kg/24h PO divided q12h **
(Dosing is based on amoxicillin component -use 25 mg/mL 4:1 ratio formulation)**

Renal

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

General Information

Common Usage

Prophylaxis and treatment of bite wounds

Polymicrobial infections of the respiratory tract or abdomen

Skin and soft tissue infections

Adverse Effects

Diarrhea (common)
Allergy/rash
Cytopenias
Hepatotoxicity due to clavulanate is usually mild. EBV related rash (not allergy)

Pharmacology

Antimicrobial class: Aminopenicillin + Beta-lactamase inhibitor

Route of Elimination: Urine (amoxicillin 50% to 70% unchanged drug; clavulanic acid 25% to 40% unchanged drug)

Average serum half life: Adults: ~1 hour. Amoxicillin pharmacokinetics are not affected by clavulanic acid