What is the recommended duration of amoxicillin-clavulanate (Augmentin) therapy in an adult male patient with normal body mass index (BMI), normal renal function, and normal liver function who has failed treatment with amoxicillin alone?

From the Guidelines

For an adult male with normal BMI and normal kidney and liver function who failed amoxicillin treatment, amoxicillin-clavulanate should typically be given for 5 to 10 days, as recommended by the clinical practice guideline for adult sinusitis 1. The standard adult dosage is 875 mg amoxicillin/125 mg clavulanate twice daily, or 500 mg amoxicillin/125 mg clavulanate three times daily. Some key points to consider when prescribing amoxicillin-clavulanate include:

• The addition of clavulanate addresses beta-lactamase producing bacteria that may have caused the initial treatment failure by inactivating the amoxicillin 1.
• Take the medication with food to minimize gastrointestinal side effects.
• Complete the entire course even if symptoms improve before finishing, as stopping early may lead to recurrence or antibiotic resistance.
• Monitor for side effects including diarrhea, nausea, and rash.
• If the patient develops severe diarrhea, they should contact their healthcare provider as this could indicate Clostridioides difficile infection. Treatment failure with amoxicillin-clavulanate may require culture and sensitivity testing to identify the specific pathogen and its antibiotic susceptibilities, as suggested by the guideline for managing treatment failure in ABRS 1.

From the FDA Drug Label

1. Dosage and Administration Amoxicillin and clavulanate potassium may be taken without regard to meals; however, absorption of clavulanate potassium is enhanced when amoxicillin and clavulanate potassium is administered at the start of a meal. The usual adult dose is one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 250 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours.

The FDA drug label does not answer the question.

From the Research

Duration of Amoxicillin-Clavulanate Treatment

The provided studies do not specify the exact duration of amoxicillin-clavulanate treatment for a patient who has failed amoxicillin alone. However, the following points can be considered:

• Amoxicillin-clavulanate is effective against a wide range of infections, including respiratory tract infections, skin infections, and urinary tract infections 2, 3, 4, 5.
• The combination of amoxicillin and clavulanic acid is used to overcome bacterial resistance to beta-lactam antibiotics 6, 4.
• The dosage and duration of treatment may vary depending on the type and severity of the infection, as well as the patient's individual characteristics, such as kidney and liver function 2, 3, 4, 5.

Key Considerations

Some key considerations for the use of amoxicillin-clavulanate include:

• The patient's normal BMI, normal kidney and liver function, which may affect the dosage and duration of treatment 2, 3, 4, 5.
• The potential for side effects, such as gastrointestinal disturbances, which may be more frequent with amoxicillin-clavulanate than with amoxicillin alone 6, 4, 5.
• The importance of using the minimum effective dose and duration of treatment to minimize the risk of resistance and side effects 2, 3, 5.

Treatment Guidelines

While the provided studies do not specify the exact duration of treatment, some general guidelines can be considered:

• For adult respiratory tract infections, amoxicillin-clavulanate may be given for 7-10 days 2, 3.
• For skin and soft tissue infections, the duration of treatment may be 7-14 days 4.
• For urinary tract infections, the duration of treatment may be 7-14 days 4.