What are the indications and doses for Augmentin (amoxicillin/clavulanate)?

Augmentin (Amoxicillin/Clavulanate): Indications and Dosing

Augmentin (amoxicillin/clavulanate) is indicated for respiratory tract infections, skin and soft tissue infections, urinary tract infections, and intra-abdominal infections, with dosing based on infection severity, patient age, and weight.

Adult Indications and Dosing

Standard Adult Dosing Options:

• Mild to Moderate Infections:
  • 500 mg/125 mg orally every 8 hours OR
  • 875 mg/125 mg orally every 12 hours 1

Specific Adult Indications:

Respiratory Tract Infections

• Community-acquired pneumonia, sinusitis, bronchitis:
  • 875 mg/125 mg orally every 12 hours OR
  • 500 mg/125 mg orally every 8 hours 1

Aspiration Pneumonia

• Outpatient treatment:
  • 875 mg/125 mg orally every 12 hours OR
  • 500 mg/125 mg orally every 8 hours 2
• Inpatient treatment:
  • 1.2 g IV every 8 hours 2

Urinary Tract Infections

• Uncomplicated UTI:
  • 500 mg/125 mg orally every 8 hours 3, 4
• Complicated UTI:
  • 875 mg/125 mg orally every 12 hours 4, 5

Intra-abdominal Infections

• Mild to moderate with adequate source control:
  • 2 g/0.2 g IV every 8 hours (immunocompetent patients) 3
• Severe or immunocompromised:
  • 4 g/0.5 g every 6 hours or 16 g/2 g by continuous infusion 3

Pediatric Indications and Dosing

Age-Based Dosing:

• Neonates and infants <12 weeks:

  • 30 mg/kg/day divided every 12 hours (based on amoxicillin component) 1
  • Use 125 mg/5 mL oral suspension 1

• Children ≥12 weeks (3 months) to <40 kg:

  • Otitis media, sinusitis, lower respiratory tract infections:
    • 45 mg/kg/day divided every 12 hours OR
    • 40 mg/kg/day divided every 8 hours 1
  • Less severe infections:
    • 25 mg/kg/day divided every 12 hours OR
    • 20 mg/kg/day divided every 8 hours 1

• Children ≥40 kg:

  • Use adult dosing recommendations 1

High-Dose Formulations

For Drug-Resistant Pathogens:

• Adults:
  • 2000 mg/125 mg (Augmentin XR) orally twice daily for respiratory infections with drug-resistant pathogens 6
• Children:
  • 90 mg/6.4 mg/kg/day in two divided doses (Augmentin ES-600) for persistent/recurrent otitis media 6

Important Clinical Considerations

Administration:

• Take at the start of a meal to enhance clavulanate absorption and minimize gastrointestinal intolerance 1
• Twice daily dosing improves compliance and has equivalent efficacy to three times daily dosing 7

Duration of Therapy:

• Respiratory infections: 5-7 days 2
• Aspiration pneumonia: 5-7 days, until patient is afebrile for 48-72 hours 2
• Acute otitis media: 10 days 1
• Intra-abdominal infections: 4 days in immunocompetent patients with adequate source control; up to 7 days in immunocompromised or critically ill patients 3

Formulation Notes:

• Two 250 mg/125 mg tablets should NOT be substituted for one 500 mg/125 mg tablet due to different clavulanate content 1
• 250 mg/125 mg tablet and 250 mg/62.5 mg chewable tablet are NOT interchangeable 1

Antimicrobial Spectrum:

• Effective against beta-lactamase-producing H. influenzae and M. catarrhalis 6
• Active against many strains of S. pneumoniae, including some with reduced penicillin susceptibility 6
• Covers many common pathogens in community-acquired infections 6, 5

Augmentin remains a cornerstone antibiotic for community-acquired infections, with formulations designed to address the increasing prevalence of resistant pathogens while maintaining a favorable safety profile.