Co-amoxiclav
General Information
A penicillin and beta-lactamase inhibitor. Do NOT use if patient is allergic to penicillin.
Amoxicillin and clavulanic acid
Formulary antimicrobial: Use in accordance with Trust guidelines
AWaRe antibiotic classification: 'Watch'. Use as per guidelines. All other indications to be discussed with Micro/ID.
For all information regarding contra-indications, interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).
Standard dose
| Oral co-amoxiclav | Intravenous co-amoxiclav | |
| Standard dose |
625mg TDS (Amoxicillin 500mg and clavulanic acid 125mg) |
1.2g TDS (Amoxicillin 1000mg and clavulanic acid 200mg) |
Obesity
Discuss with Micro/ID because other antibiotics may be more appropriate.
Renal and Hepatic impairment
Renal impairment
| eGFR (mL/min/1.73m2) |
Oral co-amoxiclav dose |
Intravenous co-amoxiclav dose |
| 30 or more |
Dose as in normal renal function |
Dose as in normal renal function |
| Less than 30 | 1.2g bd | |
| HDF/ High Flux/ PD |
Dialysed; give post-dialysis on dialysis days. Dose as in eGFR less than 30 mL/min/1.73m2 |
Note: The reference for this dosing information is Renal Drug Database and dosing is different to those in BNF and Summary of Product Characteristics.
Hepatic impairment
- Contraindicated in patients with a history of jaundice/hepatic impairment due to amoxicillin/clavulanic acid.
- No dose adjustment required. Dose with caution in hepatic impairment and monitor hepatic function at regular intervals.
- Signs and symptoms of hepatic injury can occur either during or shortly after the use of co-amoxiclav but in some cases may not become apparent until several weeks after treatment has ceased.
- Hepatic events may be severe and in extremely rare circumstances, deaths have been reported. Manufacturers state that “These have almost always occurred in patients with serious underlying disease or taking concomitant medications known to have the potential for hepatic effects".
References
- Sandoz Limited. Co-Amoxiclav 1000 mg/200 mg Powder for Solution for Injection/Infusion summary of product characteristics. Electronic medicines compendium. Last revision of the text 23/10/23. Accessed via www.medicines.org.uk Accessed 04/11/26.
- Aurobindo Pharma - Milpharm Ltd. Co-amoxiclav 500 mg/125 mg film-coated tablets summary of product characteristics. Electronic medicines compendium. Last revision of the text 9/9/26. Accessed via www.medicines.org.uk Accessed 04/11/26.
- British National Formulary. Co-amoxiclav. BNF online accessed via www.medicinescomplete.com Accessed 04/11/26.
- The Renal Drug Database. Co-amoxiclav. Last updated 14/4/26. Accessed via https://renaldrugdatabase.com Accessed 04/11/26.
- Sanford Guide [online]. Amoxicillin-clavulanate. Last updated 20/10/26. Accessed via https://webedition.sanfordguide.com. Accessed 04/11/26.
- GIG Cymru NHS Wales. All Wales antimicrobial dosing in extremes of body weight in adults. Last updated April 2022. Accessed via https://phw.nhs.wales/resources/all-wales-antimicrobial-dosing-in-extremes-of-body-weight-in-adults/ Accessed 04/11/26