What is the recommended dosage and treatment protocol for Augmentin (amoxicillin-clavulanate)?

Recommended Dosage and Treatment Protocol for Augmentin (Amoxicillin-Clavulanate)

For adults, the standard dosage of Augmentin is 875 mg amoxicillin/125 mg clavulanate twice daily for most common infections, with treatment duration typically 7-10 days depending on the infection type and severity. 1

Adult Dosing Guidelines

Standard Adult Dosing

• 875 mg amoxicillin/125 mg clavulanate twice daily (every 12 hours) 1, 2
• Maximum daily dose: 1750 mg amoxicillin component 1

Specific Infection Types (Adults)

• Skin/Soft Tissue Infections: 875/125 mg twice daily 3
• Animal Bites: 875/125 mg twice daily 3
• Sinusitis: 875/125 mg twice daily for 7-10 days 1
• Lower Respiratory Tract Infections: 875 mg every 12 hours or 500 mg every 8 hours 2
• H. pylori Infection (with duodenal ulcer):
  • Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all twice daily for 14 days 2
  • Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, three times daily for 14 days 2

Intravenous Administration (for severe infections)

• 1 g amoxicillin plus 200 mg clavulanic acid IV every 8 hours 4

Pediatric Dosing Guidelines

Standard Pediatric Dosing

• For children ≥3 months and <40 kg:
  • Mild/Moderate infections: 25 mg/kg/day of amoxicillin component divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
  • Severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2
• Maximum pediatric dose: 90 mg/kg/day, not to exceed 4000 mg/day 1

For Children <12 weeks (3 months)

• Maximum dose: 30 mg/kg/day divided every 12 hours 2
• Treatment should continue for at least 48-72 hours after patient becomes asymptomatic 2

Dosage Adjustments for Special Populations

Renal Impairment (Adults and Children ≥3 months and >40 kg)

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity 2
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours, depending on infection severity 2
• Hemodialysis: 500 mg or 250 mg every 24 hours plus additional dose during and after dialysis 2
• Patients with GFR <30 mL/min should NOT receive the 875 mg dose 2

Treatment Duration Guidelines

• Most infections: 7-10 days 1
• Streptococcus pyogenes infections: Minimum 10 days to prevent acute rheumatic fever 2
• H. pylori treatment: 14 days 2
• Severe infections may require several weeks of treatment 2

Administration Guidelines

• Take at the start of a meal to minimize gastrointestinal intolerance 2
• For oral suspension, shake well before using 2
• Continue treatment for at least 48-72 hours after patient becomes asymptomatic 2

Clinical Considerations and Caveats

Efficacy and Resistance

• Augmentin provides broad-spectrum coverage including beta-lactamase-producing pathogens 5
• Effective against respiratory pathogens including H. influenzae, M. catarrhalis, and S. pneumoniae 5
• Consider local resistance patterns when selecting therapy 1

Common Pitfalls to Avoid

1. Underdosing: Using insufficient doses for resistant pathogens can lead to treatment failure 1
2. Failure to adjust for renal function: Can lead to drug accumulation and increased side effects 1
3. Premature discontinuation: Complete the full course even if symptoms improve before completion 1
4. Inappropriate use for viral infections: Should only be used for confirmed or strongly suspected bacterial infections 2

Monitoring

• Monitor liver function in patients with hepatic impairment 1
• For prolonged therapy, periodic assessment of organ system functions is advisable

Augmentin remains a valuable antibiotic for community-acquired infections with demonstrated efficacy across multiple infection types when used at appropriate dosages for adequate durations.