Amoxicillin-Clavulanate (PO) [PEDS]

Criteria & Principles

*NOTE: There is a national shortage of many amoxicillin and amoxicillin/clavulanic acid oral preparations*  More information regarding the shortage is located here. 

Immediate release tablets (NOTES) can be split/crushed and mixed with any liquid or semisolid like applesauce and given orally or by tube. Chew tabs also can be split.

Amoxicillin-clavulanic alternative treatment options are listed below.

Condition	Targeted pathogen	Alternate Recommendation
Otitis Media* Community-Acquired Pneumonia Acute Bacterial Sinusitis	S. pneumoniae	Amoxicillin-Clavulanate (ES) 90 mg/kg/day amoxicillin Divided twice daily Alternative: cefdinir 14 mg/kg/day divided twice daily OR cefpodoxime 10 mg/kg/day divided twice daily
Pharyngitis	Group A Strep	Cephalexin 40 mg/kg/day Divided twice daily
Dental Abscess	Oral anaerobes	Amoxicillin-Clavulanate (ES) 45 mg/kg/day amoxicillin Divided twice daily Alternative: clindamycin 30-40 mg/kg/day divided every 8 hours
Pneumococcal prophylaxis, anatomic or functional asplenia	S. pneumoniae	Penicillin VK Infants and Children < 3 years old: 125mg twice daily Children > 3 years: 250mg twice daily

*Intramuscular (IM) ceftriaxone (50 mg/kg; max dose: 1000mg) may be used in AOM in cases when alternative options are unavailable

 

Adjustment of Dose & Administration

Indication-Specific Adjustment

Note: all dosing provided based on amoxicillin component

Mild to moderate infections (ex. SSTI, dental infections, and UTI)

25-45 mg/kg/day PO divided q12h (Augmentin 7:1 formulation, max 875 mg/dose)

Severe infections (ex. Streptococcus pneumoniae coverage)

90 mg/kg/day PO divided q12h (Augmentin ES 14:1 formulation, max 2,000 mg/dose)

Acute bacterial rhinosinusitis

Standard dose: 45 mg/kg/day PO divided q12h (Augmentin 7:1 formulation, max 875 mg/dose)

High dose: 90 mg/kg/day PO divided q12h (Augmentin ES 14:1 formulation, max 2,000 mg/dose)

• Consider: severe infection (systemic toxicity with fever > 39 C and threat of suppurative complications), attendance at daycare, < 2 years old, hospitalization prior 5 days, antibiotic use within prior month, or immunocompromised

Acute otitis media

90 mg/kg/day PO divided q12h (Augmentin ES 14:1 formulation, max 2,000 mg/dose)

• Consider: received amoxicillin in the past 30 days, treatment failure at 48-72 hours on amoxicillin, history of recurrent OM not responsive to amoxicillin, or coverage for beta-lactamase positive H. influenzae and M. catarrhalis is needed (purulent conjunctivitis)

Community acquired pneumonia (targeting Streptococcus pneumoniae)

90 mg/kg/day PO divided q12h (Augmentin ES 14:1 formulation, max 2,000 mg/dose)

Renal Adjustment

Based on GFR in mL/minute/1.73m²

GFR > 30: no renal adjustments

GFR < 30 or dialysis: discuss with clinical pharmacist

Hepatic Adjustment

No hepatic adjustments

Drug-Specific Information

14:1 ES formulation: for high-dose amoxicillin-clavulanate (600/42.9-mg/5-mL suspension) given q12h

7:1 formulation (400/57-mg/5-mL suspension, 875/125-mg/5-mL suspension) given q12h

Associated with GI upset and diarrhea - may take with food to minimize frequency and severity of GI side effects

May mix in milk, formula, or juice

Shake suspension well prior to use

General Notes

1. Up-to-date cost information, click here 
2. IV antimicrobials outpatient (OPAT) dosing, click here
3. Obesity dosing weight recommendations here
4. Helpful drug-drug interaction check website here 
5. When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.