Co-amoxiclav Oral: Uses, Dosing, and Precautions
Co-amoxiclav guidance for selected bacterial infections, with ratio-specific strengths, indication-specific dosing, and major hepatic and allergy precautions.
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Guide category
Oral drugs
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Prescription medicine information for clinician-guided use.
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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 combines source-derived medicine reference sections with Kenza editorial context, while leaving out the Storage and Remarks sections from the source batch.
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