What is the appropriate dosing regimen for Augmentin (amoxicillin + clavulanate) in adults and children, including adjustments for renal impairment?

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Last updated: October 28, 2026 • View editorial policy

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Augmentin Dosing

For adults with normal renal function, the standard dose is 500 mg/125 mg three times daily or 875 mg/125 mg twice daily; for children ≥3 months, the standard dose is 45 mg/kg/day of the amoxicillin component divided twice daily, or high-dose 90 mg/kg/day (maximum 4 g/day) divided twice daily for resistant organisms or severe infections. 1

Adult Dosing

Standard Dosing (Normal Renal Function)

  • Community-acquired infections (mild-moderate): 500 mg/125 mg PO three times daily OR 875 mg/125 mg PO twice daily 2
  • High-dose regimen (resistant pathogens): 2,000 mg/125 mg PO twice daily (extended-release formulation) 3, 1
  • Severe infections: Up to 4 g/day of amoxicillin component with 250 mg clavulanate 3

Renal Impairment Adjustments

For creatinine clearance <30 mL/min: Dosing frequency must be reduced 4, 5

  • The amoxicillin component accumulates more significantly than clavulanate in renal failure
  • CrCl 10-30 mL/min: 500 mg/125 mg every 12-24 hours
  • Hemodialysis patients: 500 mg/125 mg after each dialysis session 5
    • Both amoxicillin and clavulanate are significantly removed by hemodialysis (approximately 64-65% fractional removal) 5
    • Administer supplemental dose after dialysis

Critical caveat: The ratio of amoxicillin to clavulanate increases dramatically with worsening renal function (from 4.9:1 at normal function to 14.7:1 in hemodialysis patients), which maintains adequate clavulanate levels while preventing amoxicillin toxicity 4

Pediatric Dosing

Standard Dosing (≥3 months old)

Mild infections without recent antibiotic use:

  • 45 mg/kg/day of amoxicillin component divided every 12 hours 6, 1

High-dose regimen (indicated for):

  • Age <2 years
  • Daycare attendance
  • Recent antibiotic use (within 4-6 weeks)
  • Moderate-severe illness
  • Geographic areas with >10% penicillin-resistant S. pneumoniae 6

High-dose: 90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day clavulanate, divided every 12 hours (maximum 4 g amoxicillin/day) 6, 1

Specific Formulations

AUGMENTIN ES-600 (for resistant organisms):

  • 90 mg/kg/day divided every 12 hours for 10 days 1
  • Provides 600 mg amoxicillin/42.9 mg clavulanate per 5 mL
  • Not interchangeable with other Augmentin suspensions due to different clavulanate ratios 1
  • Maximum weight: 40 kg (use adult formulations beyond this) 1

Age-Specific Considerations

Infants <3 months: Limited safety data; use only when benefits outweigh risks 1

Critically ill children: May require increased dosing due to augmented renal clearance

  • Standard dosing often results in subtherapeutic levels 7
  • Consider 25 mg/kg every 4 hours (rather than every 6 hours) with 1-hour infusion for severe sepsis 7

Clinical Context by Indication

Community-Acquired Pneumonia

Children: 90 mg/kg/day (amoxicillin component) divided twice daily for β-lactamase producing H. influenzae 8

Adults with comorbidities: 875 mg/125 mg twice daily OR 2,000 mg/125 mg twice daily combined with a macrolide 2

Acute Bacterial Sinusitis

Children:

  • Standard: 45 mg/kg/day divided twice daily
  • High-dose: 90 mg/kg/day divided twice daily for moderate-severe disease 6

Adults: 2,000 mg/125 mg twice daily (extended-release) for 10 days 3

Skin and Soft Tissue Infections

Children: 25 mg/kg/day (amoxicillin component) divided twice daily 9

Adults: 875 mg/125 mg twice daily 9

Intra-Abdominal Infections (Pediatric)

200 mg/kg/day of ampicillin component (for ampicillin-sulbactam) divided every 6 hours IV 10

Important Clinical Pitfalls

  1. Formulation confusion: ES-600 suspension contains different clavulanate ratios than standard suspensions and cannot be substituted 1

  2. Renal dosing: Failure to adjust for renal impairment leads to amoxicillin accumulation and increased adverse events 4

  3. Recent evidence challenge: A 2023 large cohort study found no difference in treatment failure between amoxicillin-clavulanate vs amoxicillin alone for pediatric sinusitis, but amoxicillin-clavulanate had higher rates of GI symptoms (RR 1.15) and yeast infections (RR 1.33) 11. This suggests reserving amoxicillin-clavulanate for true β-lactamase-producing organisms rather than empiric use.

  4. Duration: For protracted bacterial bronchitis, 4 weeks provides longer time to next exacerbation compared to 2 weeks, though clinical cure rates at day 28 are similar 12

  5. Administration timing: Give at the start of meals to minimize GI intolerance and enhance clavulanate absorption 1

References

3
Guideline

antimicrobial treatment guidelines for acute bacterial rhinosinusitis.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2004

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.