Amoxicillin-Clavulanate

C. diff Risk

Medium

Oral Bioavailability

Excellent

Approximate Cost

$2/day

Dosing

500 mg PO q8h

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

Polymicrobial Infections: Infants 3 months and older: 40-50 mg/kg/24h PO divided q 8 h (using the 80 mg/mL suspension) (7:1 ratio)
Children less than 35-40 kg: use use 80 mg/mL suspension (7:1 formulation) to minimize diarrhea
Children 35-40 kg and above: 500 mg PO q8h using 500 mg tablets or use suspension; specify 80 mg/mL suspension (7:1 formulation) to minimize diarrhea. If 7:1 formulation suspension is not available then 4: 1 ratio formulation suspension can be used but may result in more diarrhea.
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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)
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Dosing based on amoxicillin component:

Community-Acquired Pneumonia (CAP): (amoxicillin is first line) (infants and children 3 months and older)
Usual dose: 45-60 mg/kg/24h PO divided q8h
High dose: 75-90 mg/kg/24h PO divided q8h.

Usual maximum adult dose for amoxicilllin for CAP is 1g PO q8h

If using 75-90 mg/kg/24h then dose as 45 mg/kg/24h of amoxicillin PLUS 30-45 mg/kg/24h of amoxicillin and clavulanate)
Children less than 35-40 kg: use use 80 mg/mL suspension (7:1 formulation) to minimize diarrhea
Children 35-40 kg and above: use 500 mg tablets or use suspension; specify 80 mg/mL suspension (7:1 formulation) to minimize diarrhea. If 7:1 formulation suspension is not available then 4: 1 ratio formulation suspension can be used but may result in more diarrhea. )
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Otitis Media: (if failure to amoxicillin) (infants and children 3 months and older) 45-60 mg/kg/24h PO divided q8h

Children less than 35-40 kg: use use 80 mg/mL suspension (7:1 formulation) to minimize diarrhea
Children 35-40 kg and above: use 500 mg tablets or use suspension; specify 80 mg/mL suspension (7:1 formulation) to minimize diarrhea. If 7:1 formulation suspension is not available then 4: 1 ratio formulation suspension can be used but may result in more diarrhea. )

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

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)

Oral Liquids

Concentration: 125 mg/31.25 mg Each 1 mL contains: Amoxicillin 25 mg and Clavulanic Acid 6.25 mg (4:1 ratio)
Stable for 10 days in refrigerator after reconstitution.

Concentration: 400 mg/57 mg Each 1 mL contains: Amoxicillin 80 mg and Clavulanic Acid 11.4 mg (7:1 ratio)
Stable for 7 days in refrigerator after reconstitution.
Taste: palatable
Not all strengths of oral liquids are listed nor are available on IWK formulary

Tablet/Capsule Strengths

Tablet 250/125 mg
Containing: Amoxicillin 250 mg and Clavulanic Acid 125 mg (2:1 ratio)

Tablet 500/125 mg
Containing: Amoxicillin 500 mg and Clavulanic Acid 125 mg (4:1 ratio)

Tablets and capsules are preferred especially over an unpleasant tasting liquid.
Not all strengths of oral tablets/capsules are listed and they are not all available on the IWK formulary.

Pharmacology

Antimicrobial class: Aminopenicillin + Beta-lactamase inhibitor

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

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