What is the recommended dosing for Augmentin (amoxicillin-clavulanate) in the treatment of pneumonia?

From the Guidelines

For the treatment of pneumonia, Augmentin (amoxicillin-clavulanate) is recommended to be dosed at 45-90 mg/kg/day of the amoxicillin component, divided into two or three doses, for children, and 875 mg amoxicillin/125 mg clavulanate orally twice daily, or 500 mg amoxicillin/125 mg clavulanate orally three times daily for adults, for 5-7 days. When considering the treatment of pneumonia with Augmentin, it's crucial to note that the dosing is based on the amoxicillin component, and the guidelines suggest that for children, the dose should not exceed the adult dose 1. Key points to consider in the treatment regimen include:

• The dose for children is 45-90 mg/kg/day divided into two or three doses, using the appropriate formulation of Augmentin, such as the 400 mg/57 mg per 5 mL suspension 1.
• For adults, the typical dosing is 875 mg amoxicillin/125 mg clavulanate orally twice daily, or 500 mg amoxicillin/125 mg clavulanate orally three times daily 1.
• The duration of treatment is usually 5-7 days, but it may vary depending on the severity of the infection and the clinical response of the patient.
• It's essential to take Augmentin with food to enhance absorption and reduce gastrointestinal side effects.
• The combination of amoxicillin and clavulanate in Augmentin provides effective coverage against many respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, including beta-lactamase producing strains 1. Some important considerations in the management of pneumonia with Augmentin include:
• Monitoring for signs of clinical improvement, such as reduction in fever, improvement in respiratory symptoms, and decrease in inflammatory markers.
• Adjusting the dose in patients with renal impairment, as the drug is excreted primarily by the kidneys.
• Being aware of potential side effects, such as gastrointestinal disturbances, allergic reactions, and interactions with other medications.

From the FDA Drug Label

For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. The recommended dosing for Augmentin (amoxicillin-clavulanate) in the treatment of pneumonia is:

• 875 mg/125 mg every 12 hours
• 500 mg/125 mg every 8 hours for more severe infections and infections of the respiratory tract, including pneumonia 2.

From the Research

Augmentin Dosing for Pneumonia

• The recommended dosing for Augmentin (amoxicillin-clavulanate) in the treatment of pneumonia is not explicitly stated in the provided studies, but we can look at the dosing regimens used in various studies:
  • A study from 1982 3 used a dosing regimen of 500 mg amoxycillin + 250 mg clavulanic acid given orally every 8 hours for 7 days in patients with lower respiratory tract infections.
  • A study from 1989 4 used a dosing regimen of amoxycillin (250 or 500 mg) plus clavulanic acid (62.5 or 125 mg) 3-times daily in children with bacterial pneumonia.
  • A study from 2004 5 mentions the development of two new high-dose amoxicillin/clavulanate formulations: Augmentin XR (2000/125 mg twice daily) for adult respiratory tract infection and Augmentin ES-600 (90/6.4 mg/kg/day in two divided doses) for pediatric use.
  • A study from 2007 6 investigated the efficacy of Augmentin SR (2000/125 mg) twice daily treatment on Haemophilus influenzae experimental pneumonia in rabbits.

Dosing Considerations

• The choice of dosing regimen may depend on the severity of the infection, the patient's age and weight, and the presence of any underlying medical conditions.
• The studies suggest that Augmentin is effective against a range of bacterial pathogens, including Haemophilus influenzae and Streptococcus pneumoniae.
• However, the emergence of drug-resistant strains may require the use of higher doses or alternative antibiotics, as mentioned in the study from 2004 5.

Pharmacokinetics and Efficacy

• The pharmacokinetic results from the study in 1982 3 show that peak levels of amoxycillin and clavulanic acid in the blood and sputum are achieved at a later time in patients with lower respiratory tract infections compared to healthy volunteers.
• The study from 2007 6 demonstrates that both conventional Augmentin and Augmentin SR have similar efficacy against H. influenzae pneumonia in a rabbit model, even when induced by a strain with an amoxicillin/clavulanic acid MIC of 4/2 mg/l.