What is the dosing of Augmentin (amoxicillin-clavulanate) for aspiration pneumonia?

Dosing of Augmentin for Aspiration Pneumonia

For aspiration pneumonia, amoxicillin-clavulanate should be dosed at 875 mg/125 mg orally every 12 hours or 500 mg/125 mg orally every 8 hours for outpatient treatment, and 1.2 g IV every 8 hours for hospitalized patients requiring intravenous therapy. 1, 2

Dosing Recommendations Based on Severity and Setting

Outpatient Treatment (Mild Aspiration Pneumonia)

• Oral therapy options:
  • Amoxicillin-clavulanate 875 mg/125 mg PO every 12 hours 1
  • Amoxicillin-clavulanate 500 mg/125 mg PO every 8 hours 1
  • Amoxicillin-clavulanate 1-2 g/125 mg PO every 12 hours (higher dose formulation) 2

Inpatient Treatment (Moderate Aspiration Pneumonia)

• Intravenous therapy:
  • Amoxicillin-clavulanate 1.2 g IV every 8 hours 2
  • Ampicillin-sulbactam 1.5-3 g IV every 6 hours (alternative) 2

Severe Aspiration Pneumonia (ICU Setting)

• Intravenous therapy:
  • Amoxicillin-clavulanate 1.2 g IV every 8 hours plus a macrolide 2
  • Consider broader coverage if risk factors for Pseudomonas or MRSA exist 2, 3

Treatment Duration

• 5-7 days is generally sufficient for most cases of aspiration pneumonia 2
• Continue until the patient is afebrile for 48-72 hours and has no more than one sign of clinical instability 3
• Treatment duration should generally not exceed 8 days in patients who respond adequately 3

Special Considerations

Administration

• Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance and enhance absorption of clavulanate 1

Dosing Caveats

• Two 250 mg/125 mg tablets should NOT be substituted for one 500 mg/125 mg tablet, as they contain the same amount of clavulanic acid (125 mg) but different amounts of amoxicillin 1
• For patients with renal impairment requiring RRT despite normal native kidney function, consider higher doses (2.2 g every 6-8 hours) with therapeutic drug monitoring 4

Monitoring Response

• Monitor vital signs, oxygenation, and clinical status daily 3
• Assess response using body temperature, respiratory parameters, hemodynamic parameters, white blood cell count, and C-reactive protein levels 3
• Consider alternative diagnoses or broader coverage if no improvement after 72 hours of therapy 3

Evidence Quality and Considerations

The recommendations are primarily based on guidelines from the American Thoracic Society and Infectious Diseases Society of America (2019) 2, as well as the FDA drug labeling for amoxicillin-clavulanate 1. These sources provide the most authoritative guidance for dosing in aspiration pneumonia.

While some studies have examined alternative antibiotics like clindamycin 5 or different dosing regimens of ceftriaxone 6 for aspiration pneumonia, the standard of care remains amoxicillin-clavulanate at the doses specified above, as it provides excellent coverage against the mixed aerobic-anaerobic flora typically involved in aspiration pneumonia.

For patients with more severe illness or risk factors for resistant organisms, combination therapy or broader spectrum agents may be necessary, as outlined in the guidelines 2, 3.