What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a renal transplant patient with impaired renal function, specifically a Glomerular Filtration Rate (GFR) of 50?

Augmentin Dosing for Renal Transplant Patient with GFR 50

For a renal transplant patient with a GFR of 50 mL/min, the standard adult dose of Augmentin (amoxicillin/clavulanate) should be used without dose adjustment. 1

Dosing Recommendations Based on GFR

The FDA drug label for Augmentin provides clear guidance for dosing in patients with impaired renal function:

• GFR > 30 mL/min: No dose adjustment required
• GFR 10-30 mL/min: Dose adjustment required (every 12 hours)
• GFR < 10 mL/min: Dose adjustment required (every 24 hours)

Since the patient has a GFR of 50 mL/min, which is above the 30 mL/min threshold, standard dosing can be used:

• 500 mg/125 mg every 12 hours, or
• 250 mg/125 mg every 8 hours

For more severe infections, particularly respiratory tract infections:

• 875 mg/125 mg every 12 hours, or
• 500 mg/125 mg every 8 hours

Special Considerations for Renal Transplant Patients

While the FDA label doesn't specifically address renal transplant recipients, these patients require careful monitoring due to:

1. Potential drug interactions with immunosuppressive medications
2. Risk of nephrotoxicity affecting the transplanted kidney
3. Possible altered drug metabolism in transplant recipients

Monitoring Recommendations

For renal transplant patients on Augmentin:

• Monitor serum creatinine and GFR closely during treatment
• Watch for signs of nephrotoxicity
• Consider potential interactions with immunosuppressive medications

Administration Guidelines

• Augmentin may be taken without regard to meals
• However, absorption of clavulanate is enhanced when taken at the start of a meal
• Taking with food also minimizes potential gastrointestinal intolerance 1

Important Caveats

• Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different amounts of clavulanic acid
• Monitor hepatic function regularly in transplant patients, as they may have altered drug metabolism
• Be vigilant for signs of opportunistic infections due to the patient's immunosuppressed state

Remember that renal function in transplant patients can fluctuate, so regular monitoring of renal function during antibiotic therapy is essential to ensure appropriate dosing throughout the treatment course.