What is the recommended dose of Augmentin (amoxicillin-clavulanate) for strep throat?

Recommended Dosage of Augmentin for Strep Throat

For strep throat treatment, amoxicillin-clavulanate (Augmentin) should be dosed at 875 mg twice daily or 500 mg three times daily for adults, and 45 mg/kg/day divided twice daily or 40 mg/kg/day divided three times daily for children, for a full 10-day course. 1, 2

Adult Dosing

• Standard adult dosing:

  • 875 mg twice daily OR
  • 500 mg three times daily
  • Duration: 10 days (to prevent rheumatic fever) 1, 2

• For severe infections:

  • Same dosing as above, but ensure full 10-day course
  • Treatment should continue for at least 48-72 hours after patient becomes asymptomatic 2

Pediatric Dosing

• Children ≥40 kg (adult weight):

  • Same as adult dosing

• Children <40 kg:

  • 45 mg/kg/day divided twice daily OR
  • 40 mg/kg/day divided three times daily
  • Duration: 10 days 1, 2

• Children <12 weeks (3 months):

  • Maximum of 30 mg/kg/day divided twice daily due to immature renal function 2

Dosing Considerations

When to Use Augmentin vs. Amoxicillin Alone

Augmentin should be used when:

• Patient has failed initial therapy with amoxicillin
• Concern for beta-lactamase producing organisms
• High risk for treatment failure 1

First-line therapy for uncomplicated strep throat is typically penicillin V or amoxicillin alone, with Augmentin reserved for treatment failures or complicated cases 1.

Renal Dosing Adjustments

For patients with impaired renal function:

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours
• 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 2

Administration Guidelines

• Take at the start of a meal to minimize gastrointestinal intolerance 2
• For oral suspension:
  • Shake well before using
  • Refrigeration is preferable but not required
  • Discard unused portion after 14 days 2

Duration of Therapy

A full 10-day course is recommended for strep throat to prevent acute rheumatic fever, even if symptoms resolve earlier 1, 2. Although some recent research suggests shorter courses (5-7 days) may be effective 3, the established standard remains 10 days to ensure complete eradication of Group A Streptococcus.

Monitoring and Follow-up

• Clinical improvement should be noted within 48-72 hours of starting therapy
• If symptoms persist or worsen after 48-72 hours, reevaluate diagnosis and consider alternative antibiotics 1
• No routine follow-up throat cultures are needed after completion of therapy if symptoms have resolved

Common Pitfalls to Avoid

1. Inadequate duration: Stopping therapy early increases risk of rheumatic fever and treatment failure
2. Improper administration: Not taking with food increases GI side effects
3. Incorrect dosing in renal impairment: Can lead to toxicity
4. Not recognizing treatment failure: Persistent symptoms after 48-72 hours should prompt reevaluation
5. Not distinguishing carriers from acute infection: Streptococcal carriers generally don't require antimicrobial therapy 1

Twice-daily dosing may improve compliance compared to three-times-daily regimens, with similar efficacy and potentially fewer gastrointestinal side effects 4.