Spectrum: Clinical Decision Support for Infectious Disease, for Jim Pattison Children's Hospital
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Antimicrobials Antimicrobials

Amoxicillin-Clavulanate

C difficile risk
Medium
Oral Bioavailability
N/A

Spectrum Of Activity

Spectrum Of Activity

Antibiogram Data

Dosing

General Pediatric

  • Dosing based on amoxicillin component

  • Max daily dose of amoxicillin is 4g/day

  • Max daily dose of clavulanate is 12.5 mg/kg/day (preferred 10mg/kg/day) Low dose: 40-50 mg/kg/DAY PO divided q8h

High dose: 80-90 mg/kg/DAY PO divided q12h

Term to 3 moInfant 3 mo to child less than 40kgChild/Adolescent greater than or equal to 40kg or greater than or equal to 16 years old4:1 30mg/kg/DAY PO divided q12h- 4:1 25-45mg/kg/DAY PO divided q8h

  • 7:1 25-45mg/kg/DAY PO divided q12h- 4:1 500mg PO q8-12h

  • 7:1 875mg PO q12h

Term to 3 mo:Infant 3 mo to child less than 40kgChild/Adolescent greater than or equal to 40kg or greater than or equal to 16 years old4:1 30mg/kg/DAY PO divided q12h- 7:1 45-60mg/kg/DAY PO divided q8h

  • 14:1 90mg/kg/DAY PO divided q8-12h (max 4g/day)- 4:1 500mg PO q8h

  • 7:1 875mg PO q12h

Term to 3 moInfant 3 mo to child less than 40kgChild/Adolescent greater than or equal to 40kg or greater than or equal to 16 years old4:1 30mg/kg/DAY PO divided q12h- 7:1 45-60mg/kg/DAY PO divided q8h

  • 14:1 90mg/kg/DAY PO divided q8h (max 4g/day)- 4:1 500mg PO q8h

  • 7:1 875mg PO q12h

To achieve 90mg/kg/day at a 14:1 ratio, combine the following:

  • Amoxicillin/Clavulanic Acid 7:1 formulation 45mg/kg/DAY PO divided q8-12h

WITH

  • Amoxicillin 45mg/kg/DAY PO divided q8-12h Example Order: Amox/Clav 200 mg (7:1 ratio) PO q8h WITH Amoxicillin 200 mg PO q8h for total 14:1 ratio

Neonatal

4:1 30 mg amoxicillin/kg/DAY PO divided q12h

Hepatic

Use with caution. Use contraindicated in patients with a history of amoxicillin and clavulanate-associated hepatic dysfunction.

Renal

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

General Information

Common Usage

Prophylaxis/treatment of bite wounds

Polymicrobial infections of the respiratory tract or abdomen

Skin and soft tissue infections

Drug Monitoring

For prolonged therapy, monitor liver enzymes and function

Adverse Effects

Diarrhea (common).

Allergy/rash, cytopenias.

Hepatotoxicity due to clavulinate is usually mild, liver failure is rare. EBV related rash (not allergy).

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)