From the FDA Drug Label
Patients with impaired renal function do not generally require a reduction in dose unless the impairment is severe. Renal impairment patients with a glomerular filtration rate of less than 30 mL/min should NOT receive the 875 mg dose
Table 2 Dosing in Patients with Severe Renal Impairment Patients with Renal Impairment Dosage Regimen GFR 10 to 30 mL/min 500 mg or 250 mg every 12 hours, depending on the severity of the infection GFR less than 10 mL/min 500 mg or 250 mg every 24 hours, depending on severity of the infection Hemodialysis 500 mg or 250 mg every 24 hours, depending on severity of the infection Administer an additional dose both during and at the end of dialysis
The recommended dosing of Amoxicillin-Clavulanate for patients with impaired renal function on dialysis is 500 mg or 250 mg every 24 hours, depending on the severity of the infection. An additional dose should be administered both during and at the end of dialysis 1.
From the Research
For patients with impaired renal function on dialysis, amoxicillin-clavulanate dosing should be adjusted to 250-500 mg every 24 hours, with an additional dose after each dialysis session. This recommendation is based on the most recent and highest quality study available, which highlights the importance of adjusting dosing to prevent accumulation and potential toxicity of amoxicillin and clavulanic acid in patients with renal impairment 2. The study suggests that high-flux haemodialysis can significantly impact the clearance of these drugs, leading to reduced concentrations and potentially decreased efficacy.
Key considerations for dosing adjustments include:
- Severity of infection: lower doses (250 mg) for mild infections and higher doses (500 mg) for more severe infections
- Patient factors: individualized dosing based on patient response and renal function
- Type of dialysis: patients on peritoneal dialysis may require slightly different adjustments
- Regular monitoring: drug levels, renal function, and clinical response should be closely monitored to ensure effective treatment and minimize adverse effects
The primary goal of these dosing adjustments is to maintain therapeutic levels of amoxicillin and clavulanic acid while minimizing the risk of accumulation and toxicity, thereby optimizing outcomes in terms of morbidity, mortality, and quality of life for patients with impaired renal function on dialysis 3, 4.