What is the recommended dosing for Augmentin (amoxicillin/clavulanate) in adults with acute otitis media?

Dosing of Augmentin for Adults with Acute Otitis Media

For adults with acute otitis media, the recommended dosage of Augmentin (amoxicillin/clavulanate) is 875 mg/125 mg twice daily for 5-7 days. 1

Dosing Options Based on Disease Severity

For Mild Disease (No Antibiotics in Previous 4-6 Weeks)

• Amoxicillin/clavulanate 1.75 to 4 g/250 mg per day 2
  • Standard dosing: 875 mg/125 mg twice daily (1.75 g/250 mg per day) 1
  • High-dose option: 2000 mg/125 mg twice daily (4 g/250 mg per day) for areas with high prevalence of resistant organisms 2
• Duration: 5-7 days 1

For Moderate Disease or Recent Antibiotic Use

• High-dose amoxicillin/clavulanate (4 g/250 mg per day) 2
• Alternative: Respiratory fluoroquinolones (gatifloxacin, levofloxacin, moxifloxacin) 2

Rationale for Dosing

• Augmentin provides coverage against common otitis media pathogens:
  • Streptococcus pneumoniae (including penicillin-intermediate strains)
  • Beta-lactamase producing Haemophilus influenzae
  • Moraxella catarrhalis 3
• Higher doses are recommended in areas with high prevalence of drug-resistant S. pneumoniae 3
• The addition of clavulanate protects amoxicillin from degradation by beta-lactamase enzymes produced by resistant H. influenzae and M. catarrhalis 3

Treatment Failure Considerations

• If no improvement after 72 hours of therapy:
  • Reevaluate the patient
  • Consider switching to an alternative antimicrobial therapy 2, 1
• For treatment failures, consider:
  • Respiratory fluoroquinolones
  • Parenteral ceftriaxone (1-2 g/day for 5 days)
  • Combination therapy with adequate gram-positive and gram-negative coverage 2

Alternative Options for Penicillin-Allergic Patients

• For non-anaphylactic reactions:
  • Cefdinir (300 mg twice daily)
  • Cefuroxime (500 mg twice daily)
  • Cefpodoxime (200 mg twice daily) 1
• For severe penicillin allergy:
  • Clindamycin 1
  • Respiratory fluoroquinolones 2
  • Note: Macrolides (azithromycin, clarithromycin) have higher bacteriologic failure rates (20-25%) 2

Common Pitfalls and Caveats

1. Dosing frequency: Twice-daily dosing has shown similar efficacy to three-times-daily dosing with better compliance and potentially fewer gastrointestinal side effects 4

2. Treatment duration: 5-7 days is typically sufficient for uncomplicated acute otitis media in adults 1

3. Resistance concerns: Standard-dose amoxicillin may be insufficient in areas with high prevalence of resistant organisms, necessitating higher doses 3

4. Gastrointestinal side effects: Diarrhea is the most common adverse effect. Consider probiotics to reduce gastrointestinal side effects 1

5. Monitoring: Reassess after 72 hours if symptoms persist or worsen 2, 1