What is the recommended dosing for Augmentin (amoxicillin-clavulanate) in adults and children with bacterial bronchitis?

Augmentin Dosing Recommendations for Bacterial Bronchitis

For bacterial bronchitis, amoxicillin-clavulanate (Augmentin) should be dosed at 875 mg/125 mg twice daily for 7-10 days in adults and 45 mg/kg/day in three divided doses (not exceeding 3 g/day) in children. 1, 2

Adult Dosing

Standard Dosing

• 875 mg/125 mg twice daily for 7-10 days 1, 3
• Alternative: 500 mg/125 mg three times daily for 7-10 days 3

High-Dose Option (for resistant organisms)

• 2000 mg/125 mg twice daily for 5 days 4
• Consider this formulation when treating patients who:
  • Have received antibiotics in the previous 4-6 weeks
  • Have risk factors for drug-resistant pathogens
  • Have failed initial therapy with standard dosing 2

Pediatric Dosing

Standard Dosing

• 45 mg/kg/day of amoxicillin component in three divided doses (not exceeding 3 g/day) 1
• For children with lower respiratory tract infections: 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours 1, 3

High-Dose Option (for resistant organisms)

• 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses 2
• Consider for children with risk factors for resistant pathogens or recent antibiotic exposure 2

Special Populations

Renal Impairment

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours
• Hemodialysis: 500 mg or 250 mg every 24 hours plus additional dose during and after dialysis 3
• Patients with GFR <30 mL/min should NOT receive the 875 mg dose 3

Treatment Duration and Monitoring

• Standard duration: 7-10 days 1, 2
• Treatment should continue for at least 48-72 hours after the patient becomes asymptomatic 3
• If no improvement after 72 hours, reevaluate diagnosis or consider alternative antibiotics 2

Clinical Considerations

When to Use Augmentin vs. Amoxicillin Alone

• Use Augmentin when beta-lactamase-producing organisms are suspected:
  • Recent antibiotic use (within 4-6 weeks)
  • Chronic bronchitis with frequent exacerbations
  • Known high prevalence of beta-lactamase producers in community 2, 5

Efficacy Considerations

• Augmentin has demonstrated high clinical success rates (>90%) in treating acute exacerbations of chronic bronchitis 6, 4
• The pharmacokinetically enhanced formulation (2000/125 mg) has shown equivalent efficacy in a shorter 5-day course compared to standard 7-day treatment 4

Administration

• Take at the start of a meal to minimize gastrointestinal intolerance 3
• Twice-daily regimens have shown similar efficacy to three-times-daily regimens with potentially better compliance 7

Common Pitfalls and Caveats

1. Recent Antibiotic Use: Patients who have received antibiotics in the previous 4-6 weeks are at higher risk for resistant organisms and may require high-dose formulations 2

2. Renal Function: Always assess renal function before prescribing, as dose adjustments are required for impaired renal function 3

3. Compliance Issues: Consider twice-daily formulations for better adherence, which has shown similar efficacy to three-times-daily dosing 7

4. Resistance Development: Complete the full prescribed course to minimize resistance development 2

5. Distinguishing Viral from Bacterial Bronchitis: Antibiotics are generally not recommended for acute bronchitis in otherwise healthy adults unless bacterial infection is strongly suspected 1