What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a 77-year-old male with community-acquired pneumonia (CAP) and impaired renal function (creatinine 2.7, GFR 23)?

From the Guidelines

For a 77-year-old male with community-acquired pneumonia and significantly impaired renal function (GFR 23 ml/min), the recommended dose of Augmentin (amoxicillin/clavulanate) should be reduced to 500 mg/125 mg twice daily. This dosage adjustment is necessary because both amoxicillin and clavulanic acid are primarily eliminated by the kidneys, and standard doses could lead to drug accumulation and toxicity in patients with renal impairment. With a GFR between 10-30 ml/min, this reduced dosing helps maintain therapeutic efficacy while minimizing adverse effects, as supported by general principles of antibiotic dosing in renal impairment 1. The patient should be monitored closely for signs of drug toxicity, including nausea, vomiting, diarrhea, and skin rash. Renal function tests should be checked periodically during treatment. The typical duration for CAP treatment is 5-7 days, but this may be extended based on clinical response. Adequate hydration should be maintained throughout the treatment course. If the patient's renal function worsens or if they show signs of drug intolerance, further dose adjustment or alternative antibiotic therapy may be necessary.

Key considerations in managing this patient include:

• Monitoring for signs of toxicity and adjusting the dose as needed
• Ensuring adequate hydration to prevent further renal impairment
• Considering alternative antibiotics if there are concerns about resistance or if the patient does not respond to Augmentin
• Following guidelines for the management of community-acquired pneumonia, such as those provided by the Infectious Diseases Society of America/American Thoracic Society 1.

It's also important to note that while the provided evidence does not directly address dosing of Augmentin in renal impairment, general principles of pharmacology and antibiotic use in patients with reduced renal function support the need for dose adjustment to prevent toxicity 1.

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

The patient has a GFR of 23, which falls into the category of less than 30 mL/min. The recommended dose for Augmentin (amoxicillin/clavulanate) is 500 mg or 250 mg every 12 hours, depending on the severity of the infection. Since the patient has community-acquired pneumonia (CAP), which can be considered a severe infection, the recommended dose would be 500 mg every 12 hours 2.

From the Research

Augmentin Dosing for CAP with Impaired Renal Function

The recommended dose of Augmentin (amoxicillin/clavulanate) for a 77-year-old male with community-acquired pneumonia (CAP) and impaired renal function (creatinine 2.7, GFR 23) is not directly stated in the provided studies. However, some general guidelines for antibiotic treatment in CAP patients can be considered:

• According to 3, patients over 65 years and/or with co-morbidities, such as impaired renal function, may be treated with oral amoxicillin/clavulanate 500/125 mg TID or 875/125 mg BID.
• It is essential to note that the dosing of Augmentin may need to be adjusted in patients with impaired renal function to avoid accumulation of the drug and potential toxicity.
• The studies provided do not specifically address the dosing of Augmentin in patients with a GFR of 23, but it is generally recommended to adjust the dose of renally cleared antibiotics, such as Augmentin, in patients with severe renal impairment.

Considerations for Renal Impairment

Some key points to consider when treating patients with impaired renal function include:

• The need to adjust antibiotic doses to prevent accumulation and potential toxicity
• The importance of monitoring renal function and adjusting doses accordingly
• The potential for drug interactions and the need to consider other medications that may be nephrotoxic

Additional Factors to Consider

Other factors that may influence the treatment of CAP in this patient include:

• The severity of the pneumonia and the need for hospitalization
• The presence of other co-morbidities, such as heart disease or diabetes
• The potential for resistance to certain antibiotics, such as penicillin or macrolides, as noted in 4 and 3