From the Research
Augmentin (amoxicillin-clavulanate) requires dose adjustment in patients with impaired renal function based on creatinine clearance (CrCl). For patients with CrCl greater than 30 mL/min, standard dosing can be used. For patients with CrCl between 10-30 mL/min, the recommended dose is 250-500 mg every 12 hours (using the standard formulation) 1. For patients with CrCl less than 10 mL/min, the dose should be reduced to 250-500 mg every 24 hours. Patients on hemodialysis should receive an additional dose during and at the end of dialysis. These adjustments are necessary because both amoxicillin and clavulanic acid are primarily eliminated by the kidneys, and reduced renal function leads to drug accumulation. Without proper dose adjustments, patients with renal impairment may experience increased side effects, including nausea, vomiting, diarrhea, and in severe cases, neurotoxicity. It's essential to monitor renal function throughout treatment and adjust dosing as needed if renal function changes, as suggested by recent studies on antibiotic dosage regimens for patients with augmented renal clearance 2. The extended-release formulation (Augmentin XR) should be avoided in patients with CrCl less than 30 mL/min as it cannot be appropriately adjusted for severe renal impairment. Key considerations in renal dosing adjustments include:
- Monitoring renal function closely
- Adjusting doses based on creatinine clearance
- Avoiding the extended-release formulation in severe renal impairment
- Being aware of the potential for drug accumulation and increased side effects in renal impairment, as highlighted in studies on the pharmacokinetics of amoxycillin and clavulanic acid in patients with end-stage renal disease 3.