Recommended Dosing of Augmentin (Amoxicillin/Clavulanate)
For adults with respiratory tract infections, the recommended dose of Augmentin is 875 mg amoxicillin/125 mg clavulanate twice daily or 500 mg amoxicillin/125 mg clavulanate three times daily, while children should receive 45 mg/kg/day of the amoxicillin component divided into two doses for severe infections. 1
Adult Dosing
Standard Formulations:
Mild to moderate infections:
- 500 mg (amoxicillin component) every 12 hours OR
- 250 mg every 8 hours
Severe infections:
- 875 mg every 12 hours OR
- 500 mg every 8 hours 1
Special Formulations:
- Augmentin XR (extended release): 2000 mg amoxicillin/125 mg clavulanate twice daily for respiratory tract infections, particularly effective against resistant Streptococcus pneumoniae 2
Special Indications:
- H. pylori infection (adults only):
- Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily for 14 days
- Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily for 14 days 1
Pediatric Dosing
Children ≥3 months and <40 kg:
Mild/moderate ear, nose, throat, skin, or genitourinary infections:
- 25 mg/kg/day divided every 12 hours OR
- 20 mg/kg/day divided every 8 hours
Severe infections or lower respiratory tract infections:
- 45 mg/kg/day divided every 12 hours OR
- 40 mg/kg/day divided every 8 hours 1
Children <12 weeks (3 months):
- Maximum dose: 30 mg/kg/day divided every 12 hours
- This lower dose is due to incompletely developed renal function 1
Special Formulation for Children:
- Augmentin ES-600: 90/6.4 mg/kg/day in two divided doses for persistent or recurrent acute otitis media with risk factors for resistant pathogens 3
Dosing in Renal Impairment
Adults and children >40 kg with severe renal impairment:
GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity
GFR <10 mL/min: 500 mg or 250 mg every 24 hours, depending on infection severity
Hemodialysis patients: 500 mg or 250 mg every 24 hours with additional doses during and after dialysis 1
Patients with GFR <30 mL/min should NOT receive the 875 mg dose 1
Duration of Therapy
- Standard infections: Continue treatment for 48-72 hours beyond symptom resolution
- Streptococcal infections: Minimum 10 days to prevent acute rheumatic fever 1
- H. pylori infection: 14 days 1
- Respiratory tract infections: 7-10 days 4
Administration Guidelines
- Take at the start of a meal to minimize gastrointestinal intolerance 1
- For oral suspension:
- Shake well before using
- Refrigeration is preferable but not required
- Discard any unused portion after 14 days 1
Common Adverse Effects and Precautions
Gastrointestinal: Diarrhea, nausea, vomiting
Hypersensitivity reactions: Rash, urticaria, anaphylaxis
Liver: Hepatic dysfunction, cholestatic jaundice
Patients with a history of penicillin allergy may experience cross-reactivity
Monitor liver function in patients with underlying liver disease
Clinical Pearls
For respiratory tract infections, the higher dose formulations (875 mg twice daily or 2000 mg XR) are preferred due to increasing prevalence of resistant pathogens 3
Augmentin should be used only for infections proven or strongly suspected to be caused by bacteria to reduce development of drug-resistant bacteria 1
When treating streptococcal pharyngitis, ensure a full 10-day course to prevent rheumatic fever 5
In areas with high prevalence of resistant S. pneumoniae, consider the extended-release formulation (Augmentin XR) for adults 2
For patients with penicillin allergy, consider alternative antibiotics like clindamycin 4
By following these dosing recommendations and considering patient-specific factors like age, weight, renal function, and infection severity, Augmentin can be used effectively and safely for a variety of bacterial infections.