Augmentin Dosing Recommendations
For adults with skin and soft tissue infections or respiratory tract infections, prescribe Augmentin 875/125 mg twice daily; for children, use 45 mg/kg/day (of amoxicillin component) divided twice daily, or 90 mg/kg/day divided twice daily for resistant organisms in acute otitis media. 1, 2
Adult Dosing
Standard Formulation
- 875/125 mg twice daily is the preferred regimen for most community-acquired infections 1, 3
- This dosing is as effective as 500/125 mg three times daily but offers better compliance 4
- Take at the start of meals to minimize gastrointestinal side effects and enhance clavulanate absorption 2
High-Dose Formulation (Augmentin XR)
- 2000/125 mg twice daily for drug-resistant pathogens, particularly in respiratory infections 5, 6
- Provides extended therapeutic levels over the 12-hour dosing interval
- Effective against S. pneumoniae with penicillin MICs ≤4 mcg/mL
Specific Indications from Guidelines
For impetigo: 875/125 mg twice daily 1
For animal/human bites: 875/125 mg twice daily 3
Pediatric Dosing
Standard Dosing
- 45 mg/kg/day (based on amoxicillin component) divided every 12 hours 1, 3
- Alternative: 25 mg/kg/day in 2 divided doses for impetigo 1
High-Dose Formulation (Augmentin ES-600)
- 90 mg/kg/day divided every 12 hours for 10 days 2
- Specifically for:
- Persistent or recurrent acute otitis media
- Acute bacterial sinusitis
- Infections with risk factors for β-lactamase-producing organisms or resistant S. pneumoniae
- Only for children ≥3 months and <40 kg 2
- Contains 42.9 mg clavulanate per 5 mL (higher than standard formulations) 2
Key Clinical Considerations
Twice-daily dosing is equivalent to three-times-daily dosing for efficacy but improves compliance and reduces diarrhea rates 7, 8. Studies demonstrate 93-94% clinical success rates with both regimens 4, 8.
Common pitfalls to avoid:
- Do not substitute standard Augmentin suspensions for ES-600 formulation—they contain different clavulanate concentrations and are not interchangeable 2
- Do not use ES-600 in adults or children >40 kg 2
- Monitor for gastrointestinal adverse events, particularly diarrhea (occurs in 7-13% of patients) 2, 9
Adverse event profile: Amoxicillin-clavulanate carries higher risk of gastrointestinal symptoms (RR 1.15) and yeast infections (RR 1.33) compared to amoxicillin alone, though treatment failure rates are equivalent 9. This is particularly relevant in children ages 0-11 years where adverse events are more common 9.
Resistance considerations: While amoxicillin-clavulanate remains effective for most community-acquired infections 10, rising ESBL prevalence in E. coli may limit its utility for empirical UTI treatment in some regions 11, 12. Local antibiograms should guide therapy selection.
Duration: Most respiratory and skin infections require 7-10 days of therapy 1, 3. Shorter 5-day courses of high-dose formulations (2000/125 mg) are as effective as 7-day standard courses for acute exacerbations of chronic bronchitis 5.