1 May 2026Oral drugs
Amoxicillin/Clavulanic acid = Co-amoxiclav oral
Co-amoxiclav guidance for selected bacterial infections, with ratio-specific strengths, indication-specific dosing, and major hepatic and allergy precautions.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Combination of two antibacterials. The addition of clavulanic acid to amoxicillin extends its spectrum of activity to cover beta-lactamase producing Gram-positive and Gram-negative organisms, including some Gram-negative anaerobes.
Indications
- Animal bites, if antibiotic therapy or antibiotic prophylaxis is clearly indicated.
- Second line treatment of acute otitis media and acute bacterial sinusitis, when amoxicillin alone given at high dose failed.
- Acute uncomplicated cystitis with no systemic signs in girls over 2 years.
- Postpartum upper genital tract infection.
- Parenteral to oral switch therapy in severe infections such as severe pneumonia.
Forms and strengths
The ratio of amoxicillin and clavulanic acid varies according to the manufacturer.
Ratio 8:1
- 500 mg amoxicillin/62.5 mg clavulanic acid tablet.
- 500 mg amoxicillin/62.5 mg clavulanic acid/5 ml powder for oral suspension.
Ratio 7:1
- 875 mg amoxicillin/125 mg clavulanic acid tablet.
- 400 mg amoxicillin/57 mg clavulanic acid/5 ml powder for oral suspension.
- 200 mg amoxicillin/28.5 mg clavulanic acid dispersible tablet.
Dose (expressed in amoxicillin)
Animal bites; second line treatment of acute otitis media and acute sinusitis
- Child < 40 kg: 25 mg/kg 2 times daily.
- Child >= 40 kg and adult, ratio 8:1: 2000 mg daily = 2 tablets of 500/62.5 mg 2 times daily.
- Child >= 40 kg and adult, ratio 7:1: 1750 mg daily = 1 tablet of 875/125 mg 2 times daily.
Acute uncomplicated cystitis in girls > 2 years
- 12.5 mg/kg 2 times daily.
Postpartum upper genital tract infection; parenteral to oral switch therapy in severe infections
- Child < 40 kg: 50 mg/kg 2 times daily.
- Child >= 40 kg and adult, ratio 8:1: 3000 mg daily = 2 tablets of 500/62.5 mg 3 times daily.
- Child >= 40 kg and adult, ratio 7:1: 2625 mg daily = 1 tablet of 875/125 mg 3 times daily.
Duration
- Animal bites: 5 to 7 days.
- Otitis media: 5 days.
- Sinusitis: 7 to 10 days.
- Cystitis: 3 days.
- Upper genital tract infection: 7 days.
- Parenteral to oral switch therapy in severe pneumonia: complete a total of 10 to 14 days of treatment.
Contra-indications, adverse effects, precautions
- Do not administer to penicillin-allergic patients and patients with a history of hepatic disorders during a previous treatment with co-amoxiclav.
- Administer with caution to patients allergic to cephalosporins because cross-sensitivity may occur.
- Administer with caution to patients with hepatic impairment; reduce dosage and give every 12 or 24 hours in patients with severe renal impairment.
- May cause gastrointestinal disturbances, mainly diarrhoea.
- May cause allergic reactions, sometimes severe; stop treatment immediately.
- May cause jaundice and cholestatic hepatitis in the event of prolonged treatment beyond 10 to 15 days.
- The dose of clavulanic acid should not exceed 12.5 mg/kg daily or 375 mg daily.
- Pregnancy: no contra-indication.
- Breast-feeding: no contra-indication.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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