What is the usual dosage of Augmentin (amoxicillin/clavulanate) for prostatitis?

Dosage of Augmentin for Prostatitis

For prostatitis treatment, Augmentin (amoxicillin/clavulanate) should be dosed at 875 mg amoxicillin/125 mg clavulanate twice daily for 2-4 weeks, depending on whether it's acute or chronic bacterial prostatitis.

Understanding Prostatitis and Antimicrobial Selection

Prostatitis is a frequent urological diagnosis, but fewer than 10% of cases are confirmed to have bacterial infection 1. When bacterial prostatitis is diagnosed, it's important to understand:

• Enterobacterales are the primary pathogens in acute bacterial prostatitis (ABP)
• Chronic bacterial prostatitis (CBP) involves a broader spectrum of pathogens, including atypical microorganisms

Antimicrobial Penetration Considerations

The effectiveness of antibiotics in treating prostatitis depends on their ability to penetrate prostatic tissue and fluid. Key factors affecting penetration include:

• Lipid solubility
• Dissociation constant (pKa)
• Protein binding

Beta-lactam antibiotics like Augmentin generally have:

• Low pKa
• Poor lipid solubility
• Variable penetration into prostatic tissue 2

However, studies have shown that amoxicillin/clavulanate can achieve therapeutic concentrations in prostatic tissue, with measurements showing:

• Amoxicillin: Variable levels in prostatic tissue
• Clavulanic acid: Approximately 0.20 μg/g in prostatic tissue 3

Treatment Duration

Treatment duration varies based on the type of prostatitis:

• Acute bacterial prostatitis: 2 weeks
• Chronic bacterial prostatitis: 4 weeks

Alternative Treatments

If Augmentin fails or is contraindicated, consider:

• Fluoroquinolones (if local resistance patterns permit)
• Trimethoprim-sulfamethoxazole
• Cephalosporins (selected agents with better prostatic penetration)

Important Clinical Considerations

1. Diagnostic evaluation before treatment:

   • Perform Meares and Stamey 2- or 4-glass test for chronic bacterial prostatitis 1
   • Take midstream urine culture to guide antibiotic selection 1
   • Consider transrectal ultrasound to rule out prostatic abscess in selected cases 1

2. Treatment pitfalls to avoid:

   • Inadequate treatment duration (too short)
   • Failure to consider prostatic calculi (associated with lower cure rates)
   • Not accounting for local antimicrobial resistance patterns

3. Monitoring:

   • Assess clinical response within 48-72 hours
   • Consider follow-up cultures after completing therapy to confirm eradication

Special Considerations

• For patients with recurrent infections, longer treatment courses may be necessary
• Prostatic calculi may reduce treatment success rates 4
• Consider collaborative management involving urologists and infectious disease specialists in complex cases 1

Remember that proper diagnosis is crucial, as most cases of prostatitis are not bacterial in origin, and antimicrobial therapy is only indicated for confirmed bacterial prostatitis.