Co-amoxiclav 625mg (Augmentin)
Brand names: Augmentin
Co-amoxiclav combines amoxicillin with clavulanic acid and is used for infections likely to involve beta-lactamase–producing bacteria, including some ENT, respiratory, urinary and skin infections.
Adult dose
Paediatric dose
Dose adjustments
§4.2 Renal impairment (dose adjustments are based on the maximum recommended level of amoxicillin): 'No adjustment in dose is required in patients with creatinine clearance (CrCl) greater than 30 ml/min.' Adults and children weighing 40 kg or more — CrCl 10-30 ml/min: '500 mg/125 mg twice daily'; CrCl < 10 ml/min: '500 mg/125 mg once daily'; haemodialysis: '500 mg/125 mg every 24 hours, plus 500 mg/125 mg during dialysis, to be repeated at the end of dialysis (as serum concentrations of both amoxicillin and clavulanic acid are decreased)'. Children under 40 kg — CrCl 10-30 ml/min: '15 mg/3.75 mg/kg twice daily (maximum 500 mg/125 mg twice daily)'; CrCl < 10 ml/min: '15 mg/3.75 mg/kg as a single daily dose (maximum 500 mg/125 mg)'; haemodialysis: '15 mg/3.75 mg/kg per day once daily. Prior to haemodialysis 15 mg/3.75 mg/kg. In order to restore circulating drug levels, 15 mg/3.75 mg per kg should be administered after haemodialysis.' §4.4 also notes convulsions may occur in patients with impaired renal function.
§4.2 Hepatic impairment: 'Dose with caution and monitor hepatic function at regular intervals (see sections 4.3 and 4.4).' No numeric reduction is given. Note the §4.3 contraindication: 'History of jaundice/hepatic impairment due to amoxicillin/clavulanic acid'. US label §2.4 agrees: 'Hepatically impaired patients should be dosed with caution and hepatic function monitored at regular intervals'.
Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.
US labelling (FDA)
Reference — US labelling, may differ from UKAdults and Pediatric Patients greater than 40 kg: 500 or 875 mg every 12 hours or 250 or 500 mg every 8 hours, based on the amoxicillin component. ( 2.2 , 2.3 ) Pediatric patients aged 12 weeks (3 months) and older: 25 to 45 mg/kg/day every 12 hours or 20 to 40 mg/kg/day every 8 hours, up to the adult dose. ( 2.3 ) Neonates and infants less than 12 weeks of age: 30 mg/kg/day divided every 12 hours, based on the amoxicillin component. Use of the 125 mg/5 mL oral suspension is recommended. ( 2.3 ) 2.1 Important Administration Instructions Amoxicillin and Clavulanate Potassium may be taken without regard to meals; however, absorption of clavulanate potassium is enhanced when Amoxicillin and …
Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-04-30. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.
Contraindications
- Hypersensitivity to the active substances, to any of the penicillins or to any of the excipients listed in section 6.1 (§4.3)
- History of a severe immediate hypersensitivity reaction (e.g. anaphylaxis) to another beta-lactam agent (e.g. a cephalosporin, carbapenem or monobactam) (§4.3)
- History of jaundice/hepatic impairment due to amoxicillin/clavulanic acid (§4.3)
- Avoid if infectious mononucleosis is suspected — §4.4: 'Amoxicillin/clavulanic acid should be avoided if infectious mononucleosis is suspected since the occurrence of a morbilliform rash has been associated with this condition following the use of amoxicillin' (caution, not a formal §4.3 contraindication)
- Not for use where reduced susceptibility is not beta-lactamase mediated — §4.4: 'This presentation of Augmentin is not suitable for use when there is a high risk that the presumptive pathogens have reduced susceptibility or resistance to beta-lactam agents that is not mediated by beta-lactamases susceptible to inhibition by clavulanic acid. This presentation should not be used to treat penicillin-resistant S. pneumoniae.'
Side effects
- Gastrointestinal — diarrhoea: very common (≥1/10). Nausea and vomiting: common. §4.8: 'The most commonly reported adverse drug reactions (ADRs) are diarrhoea, nausea and vomiting'; 'Nausea is more often associated with higher oral doses. If gastrointestinal reactions are evident, they may be reduced by taking amoxicillin/clavulanic acid with a meal'
- Gastrointestinal — indigestion: uncommon. Frequency not known: antibiotic-associated colitis (including pseudomembranous and haemorrhagic colitis), drug-induced enterocolitis syndrome, acute pancreatitis, black hairy tongue
- Infections — mucocutaneous candidosis: common; overgrowth of non-susceptible organisms: frequency not known
- Skin — rash, pruritus and urticaria: uncommon; erythema multiforme: rare; frequency not known: Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous exfoliative dermatitis, acute generalised exanthematous pustulosis (AGEP), DRESS, symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), linear IgA disease
- Hepatobiliary — rises in AST and/or ALT: uncommon; hepatitis and cholestatic jaundice: frequency not known
- Blood — reversible leucopenia (including neutropenia) and thrombocytopenia: rare; frequency not known: reversible agranulocytosis, haemolytic anaemia, prolongation of bleeding time and prothrombin time
- Nervous system — dizziness and headache: uncommon; frequency not known: reversible hyperactivity, convulsions, aseptic meningitis. §4.4: 'Convulsions may occur in patients with impaired renal function or in those receiving high doses'
- Immune (frequency not known) — angioneurotic oedema, anaphylaxis, serum sickness-like syndrome, hypersensitivity vasculitis, haemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome; cardiac: Kounis syndrome. §4.4: 'Hypersensitivity reactions can also progress to Kounis syndrome, a serious allergic reaction that can result in myocardial infarction'
- Drug-induced enterocolitis syndrome (§4.4): 'reported mainly in children receiving amoxicillin/clavulanic acid… an allergic reaction with the leading symptom of protracted vomiting (1-4 hours after drug administration) in the absence of allergic skin or respiratory symptoms… There have been severe cases including progression to shock'
- Renal (frequency not known) — interstitial nephritis, crystalluria including acute renal injury
- This side-effect list may be incomplete — check the full SPC.
Monitoring
- Hepatic function — §4.2 Hepatic impairment: 'Dose with caution and monitor hepatic function at regular intervals'; US label §5.4: 'Monitor liver function tests in patients with hepatic impairment' and 'Discontinue if signs/symptoms of hepatitis occur'
- Duration of therapy — §4.2: 'The duration of therapy should be determined by the response of the patient… Treatment should not be extended beyond 14 days without review'
- Diarrhoea — evaluate for antibiotic-associated / Clostridioides difficile colitis; US label §5.5 lists 'Clostridioides difficile - associated diarrhea (CDAD) (ranging from mild diarrhea to fatal colitis): Evaluate patients if diarrhea occurs.'
- Rash — US label §5.2 (severe cutaneous adverse reactions): 'Monitor closely. Discontinue if rash progresses'; UK §4.8 footnote: 'If any hypersensitivity dermatitis reaction occurs, treatment should be discontinued'
- HLH/MAS — §4.4: 'Clinical signs and symptoms of HLH/MAS include fever, rash, neurological symptoms, hepatosplenomegaly, lymphadenopathy, cytopenias, high serum ferritin, hypertriglyceridaemia and abnormalities of liver function and coagulation. Patients who develop these signs and symptoms should be immediately evaluated'
- INR / prothrombin time when co-prescribed with an oral anticoagulant — US label §7.2: 'Abnormal prolongation of prothrombin time (increased international normalized ratio [INR]) has been reported… Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently'
- Renal function informs the dose — §4.2: 'The dose… should take into account… The age, weight and renal function of the patient'
Clinical monograph
How it works
Amoxicillin inhibits bacterial cell-wall synthesis; clavulanic acid inhibits beta-lactamase enzymes, restoring activity against many resistant organisms.
Prescribing in practice
- Reserve it for indications where added beta-lactamase cover is needed, to limit resistance and adverse effects.
- It carries a higher risk of cholestatic hepatitis (especially in older patients and with prolonged courses) and of diarrhoea than amoxicillin alone.
- Contraindicated in penicillin allergy and in a history of co-amoxiclav–associated jaundice/hepatic dysfunction.
Monitoring
Short courses need no routine monitoring; consider liver function with prolonged or repeated use.
Counselling the patient
- Complete the course; take it with food to reduce stomach upset.
- Report a rash, yellowing of the skin or eyes, or severe diarrhoea.
Evidence & guidelines
Used per local antimicrobial guidance where beta-lactamase cover is required.
Reference: NICE NG98 AOM; NICE NG120 Sinusitis; PHE Antibiotic Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- SMART2 Risk Score for Recurrent Vascular Events · Cardiovascular Risk
- MAGGIC Heart Failure Risk Score · Heart Failure
- Long QT Syndrome (Schwartz Score) · Channelopathy / Sudden Cardiac Death
- PCSK9 Inhibitor Eligibility (NICE TA393 / TA394) · Lipid Management
- Random C-Peptide — Diabetes Classification · Diabetes Classification
- Centor / McIsaac Score for Strep Pharyngitis · Throat
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020