What is the recommended dosage of Augmentin (amoxicillin/clavulanate) for treating infections?

Augmentin (Amoxicillin/Clavulanate) Dosage Guidelines

For adults, the standard Augmentin dosage is 875 mg amoxicillin/125 mg clavulanate twice daily or 500 mg amoxicillin/125 mg clavulanate every 8 hours for most infections, with dosage adjustments required for renal impairment. 1, 2

Adult Dosing

Standard Dosing

• Mild to moderate infections: 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours 1
• Severe infections and respiratory tract infections: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 1
• Maximum daily dose: 1750 mg amoxicillin component per day 2

Special Considerations

• Take at the start of a meal to minimize gastrointestinal intolerance and enhance clavulanate absorption 1
• Two 250 mg/125 mg tablets should NOT be substituted for one 500 mg/125 mg tablet due to different clavulanic acid content 1

Pediatric Dosing

By Age Group

• Neonates and infants <12 weeks: 30 mg/kg/day divided every 12 hours (based on amoxicillin component) 1
• Children ≥12 weeks:
  • More severe infections (otitis media, sinusitis, lower respiratory tract): 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

High-Dose Therapy

• For areas with high prevalence of nonsusceptible S. pneumoniae (>10%), consider high-dose amoxicillin-clavulanate (80-90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses) 3
• Maximum pediatric dose: 4000 mg/day 2

Weight-Based Considerations

• Children weighing ≥40 kg should follow adult dosing recommendations 1
• The 250 mg/125 mg tablets should not be used until the child weighs at least 40 kg 1

Dosing in Special Populations

Renal Impairment

• GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours, depending on infection severity 1
• GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours, depending on infection severity 1
• Hemodialysis patients: 500 mg/125 mg or 250 mg/125 mg every 24 hours with additional doses during and at the end of dialysis 1
• Patients with GFR <30 mL/min should NOT receive the 875 mg/125 mg dose 1

Duration of Therapy

• Treatment duration depends on the specific infection being treated
• For acute otitis media: 10 days is the recommended duration 1
• For sinusitis: 7-10 days 2
• For complicated UTI: 10-14 days 2

Common Pitfalls to Avoid

1. Incorrect substitution of tablets: Different formulations contain different amounts of clavulanic acid and are not interchangeable 1
2. Inadequate dosing for resistant organisms: In areas with high resistance rates, standard doses may be insufficient 3, 2
3. Failure to adjust for renal function: Can lead to accumulation and increased risk of side effects 2, 1
4. Poor timing of administration: Taking without food can reduce clavulanate absorption and increase GI side effects 1
5. Premature discontinuation: Complete the full course of therapy even if symptoms improve to prevent recurrence and resistance development 2

The twice-daily regimen is generally preferred as it is associated with significantly less diarrhea than three-times-daily dosing 1, 4.