From the FDA Drug Label
- 5 Geriatric Use Of the 3,119 patients in an analysis of clinical studies of amoxicillin and clavulanate potassium, 32% were ≥65 years old, and 14% were ≥75 years old No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out This drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
- 6 Dosing in Renal Impairment Amoxicillin is primarily eliminated by the kidney and dosage adjustment is usually required in patients with severe renal impairment (GFR < 30 mL/min).
A 68-year-old patient with potential impaired renal function can be prescribed Augmentin (amoxicillin/clavulanate), but care should be taken in dose selection. It is recommended to monitor renal function due to the increased risk of adverse reactions in patients with impaired renal function 1. Dosage adjustment may be necessary, especially if the patient has severe renal impairment.
From the Research
Augmentin (amoxicillin/clavulanate) can be prescribed to a 68-year-old patient, but dosage adjustments are necessary based on the patient's specific renal function status. When considering the use of Augmentin in elderly patients, particularly those with potential impaired renal function, it's crucial to prioritize their renal function status due to the potential for drug accumulation and increased risk of adverse effects 2. The most recent and highest quality study, from 2024, indicates that amoxicillin-clavulanate may be a useful alternative therapy for the treatment of certain urinary tract infections, suggesting its potential efficacy in older adults with impaired renal function 2.
Key Considerations for Dosage Adjustments
- For patients with mild impairment (creatinine clearance 30-60 mL/min), Augmentin can typically be given at 500/125 mg twice daily instead of three times daily.
- For moderate impairment (creatinine clearance 10-30 mL/min), the dose should be reduced to 500/125 mg once daily.
- In severe impairment (creatinine clearance <10 mL/min), Augmentin should be used with extreme caution, possibly at 500/125 mg every 24 hours, and alternative antibiotics might be considered.
Importance of Renal Function Tests
Before prescribing Augmentin to a 68-year-old patient with potential impaired renal function, it's essential to obtain current renal function tests, including serum creatinine and estimated glomerular filtration rate (eGFR) 3, 2. This precaution is necessary because both amoxicillin and clavulanic acid are eliminated primarily through the kidneys, and impaired renal function can lead to drug accumulation, increasing the risk of toxicity and adverse effects.
Recent Evidence Supporting Augmentin Use
Recent studies from 2024 support the use of amoxicillin-clavulanate as an effective treatment option for urinary tract infections caused by certain resistant bacteria, including extended-spectrum beta-lactamase-producing Escherichia coli 2, 4. These findings are significant for elderly patients who may be more susceptible to such infections and have impaired renal function, emphasizing the need for careful consideration of renal function when prescribing Augmentin.