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 <30 mL/min should not receive the 875-mg dose Patients with a glomerular filtration rate of 10 to 30 mL/min should receive 500 mg or 250 mg every 12 hours, depending on the severity of the infection.
The recommended dosing for Augmentin in a patient with a GFR of 25 is 500 mg or 250 mg every 12 hours, depending on the severity of the infection 1.
From the Research
For patients with severe renal impairment and a GFR of 25 mL/min, the recommended dosing for Augmentin (amoxicillin/clavulanate) should be reduced to 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours. Dose adjustment is necessary because both amoxicillin and clavulanic acid are primarily eliminated by the kidneys, and impaired renal function leads to drug accumulation and potential toxicity 2. For patients with GFR between 10-30 mL/min, this modified dosing helps maintain therapeutic efficacy while reducing the risk of adverse effects. If the GFR drops below 10 mL/min, further dose reduction to 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours may be required. During treatment, it's essential to monitor renal function, particularly in elderly patients or those with fluctuating kidney function 3. Patients should be observed for signs of toxicity such as nausea, vomiting, diarrhea, or skin rash, which might indicate the need for further dose adjustment. Adequate hydration should be maintained throughout treatment to support renal function. It is also crucial to note that the definition and classification of renal impairment may differ among various drug information sources, which can lead to inconsistencies in dosing recommendations 4. Therefore, it is vital to consult the most recent and reliable sources when adjusting medication dosages for patients with renal impairment. In the case of Augmentin, the dose adjustment should be based on the patient's GFR and the potential risks of toxicity and adverse effects 5.
Some key points to consider when dosing Augmentin in patients with severe renal impairment include:
- Monitoring renal function and adjusting the dose accordingly
- Maintaining adequate hydration to support renal function
- Observing patients for signs of toxicity and adverse effects
- Consulting reliable and up-to-date sources for dosing recommendations
- Considering the potential risks and benefits of dose adjustment in patients with renal impairment.
Overall, the goal of dose adjustment in patients with renal impairment is to maintain therapeutic efficacy while minimizing the risk of adverse effects and toxicity 6. By carefully considering the patient's GFR, renal function, and potential risks, healthcare providers can make informed decisions about dosing Augmentin and other medications in patients with severe renal impairment.