OBJECTIVES: Amoxicillin combined with clavulanic acid (co-amoxiclav) is prescribed for a wide range of bacterial infections.  It is available commercially in various fixed-dose combinations.  The primary aim was to analyse the dispensing patterns of co-amoxiclav to elderly patients with emphasis on the cost and spectrum of fixed-dose combinations.  METHODS: A retrospective drug utilisation study was conducted on a South African dispensing database for 2013. Prescriptions for co-amoxiclav to patients 60 years and older were analysed.  RESULTS:  A total of 51 951 co-amoxiclav products were dispensed to 37 949 elderly patients at a cost of R6 548 743.70.  Patients were dispensed on average 1.37 (SD=0.83) co-amoxiclav products during the year.  The average age of patients was 69.27 (SD=7.74) years.  More products were dispensed to male patients (56.47% of products).  Most products were tablets, followed by suspensions (2.85%).  The average cost per product was R126.06 (SD=R51.11).  The average cost of originator products was R166.02 compared to R107.86 for generic equivalents.  Prescribing peaked in the winter months (May to August; 39.09% of products).  Ten different dosage strengths and formulations were dispensed.  The combination of 125 mg clavulanic acid and 875 mg amoxicillin in tablet form was the most frequently dispensed (59.94% of all products), followed by 125 mg clavulanic acid and 500 mg amoxicillin (14.70% of all products).  One trade name product accounted for 31.29% of all co-amoxiclav products dispensed.  The 62.5 mg clavulanic acid and 250 mg amoxicillin per 5 ml suspension was the most frequently dispensed suspension. Interestingly, most suspensions (81.24%) were dispensed to older patients (60 to 69 years).  Only 9.92% of products were linked to ICD-10 codes.  Of these, diseases of the respiratory system (J) were the most common.  CONCLUSIONS:   One specific combination and trade name dominated dispensing.  Generics were on average two-thirds of the cost of originator products.