What are the dosage recommendations for Augmentin (amoxicillin-clavulanate) in patients with impaired renal function?

From the Guidelines

Augmentin dosing in patients with impaired renal function should be adjusted based on creatinine clearance (CrCl) to prevent drug accumulation and potential toxicity. When considering antibiotic prophylaxis for patients with renal impairment, it's crucial to choose drugs that are not nephrotoxic and to adjust doses according to the degree of renal function impairment 1. For Augmentin, which contains amoxicillin and clavulanic acid, both of which are primarily eliminated by the kidneys, dose adjustments are necessary to avoid toxicity.

Key Considerations

• For patients with CrCl 30-70 mL/min, the standard dose of Augmentin can be used but with an extended interval, typically every 12 hours instead of every 8 hours.
• For patients with CrCl 10-30 mL/min, the dose should be reduced to 250-500 mg every 12 hours.
• For severe renal impairment with CrCl less than 10 mL/min, the dose should be further reduced to 250-500 mg every 24 hours.
• Hemodialysis patients should receive a dose after each dialysis session in addition to their regular schedule, as suggested for amoxicillin in similar contexts 1.

Monitoring and Formulation

Monitoring renal function before and during therapy is important, and signs of toxicity such as seizures, confusion, or rash should prompt immediate medical attention. The specific formulation of Augmentin being used (standard, XR, or ES) will also influence the exact dosing adjustments needed. Given the potential for drug accumulation and toxicity, it's essential to follow these guidelines closely to ensure patient safety and effectiveness of the antibiotic regimen.

From the FDA Drug Label

Patients with impaired renal function do not generally require a reduction in dose unless the impairment is severe. Renal impairment patients with a glomerular filtration rate of <30 mL/min should not receive the 875 mg/125 mg dose Patients with a glomerular filtration rate of 10 to 30 mL/min should receive 500 mg/125 mg or 250 mg/125 mg every 12 hours, depending on the severity of the infection. Patients with a glomerular filtration rate less than 10 mL/min should receive 500 mg/125 mg or 250 mg/125 mg every 24 hours, depending on severity of the infection Hemodialysis patients should receive 500 mg/125 mg or 250 mg/125 mg every 24 hours, depending on severity of the infection. They should receive an additional dose both during and at the end of dialysis.

The dosage recommendations for Augmentin (amoxicillin-clavulanate) in patients with impaired renal function are as follows:

• Glomerular filtration rate <30 mL/min: Do not use 875 mg/125 mg dose
• Glomerular filtration rate 10-30 mL/min: Use 500 mg/125 mg or 250 mg/125 mg every 12 hours
• Glomerular filtration rate <10 mL/min: Use 500 mg/125 mg or 250 mg/125 mg every 24 hours
• Hemodialysis patients: Use 500 mg/125 mg or 250 mg/125 mg every 24 hours, with an additional dose during and at the end of dialysis 2

From the Research

Dosage Recommendations for Augmentin in Patients with Impaired Renal Function

The dosage of Augmentin (amoxicillin-clavulanate) in patients with impaired renal function requires careful consideration to avoid toxicity and ensure efficacy.

• The estimated glomerular filtration rate (eGFR) can be used to guide dose adjustment in patients with stable kidney function 3.
• However, alternative methods such as the Cockcroft-Gault formula or direct measures of glomerular filtration rate using exogenous isotope compounds may be necessary in certain patient subsets 3.
• A study found that 51.6% of patients with chronic kidney disease (CKD) received antibiotics without renal dose adjustments, with penicillins being the most inappropriately dosed class 4.
• Another study provided an evidence-based update of infectious disease recommendations for health professionals managing patients with CKD, including dose adjustments for antibiotics 5.
• The optimal antibiotic dosage for CKD patients is crucial to prevent adverse effects and ensure efficacy, and dosage adjustment is one of the vital elements to be familiar with during their oral care 6.
• Appropriate dosage adjustments for patients with CKD are critical for patient safety, and important patient teaching information for over-the-counter (OTC) medications should be provided 7.

Key Considerations

• Close monitoring of drug effect and toxicity is necessary, and can be supported by therapeutic drug monitoring 3.
• The renal dosing adjustment of antibiotics is crucial to avoid toxicity and decrease mortality in patients with CKD 4.
• Collaboration with clinical pharmacists and increasing awareness of prescribing physicians can help prevent dosing errors in patients with CKD 4.