Augmentin (Amoxicillin-Clavulanate) Dosing Guidelines
For adults and pediatric patients with bacterial infections, amoxicillin-clavulanate (Augmentin) should be dosed based on the specific infection type, severity, and patient characteristics, with amoxicillin-clavulanate rather than amoxicillin alone recommended for most respiratory and skin infections. 1, 2
Adult Dosing
Standard Dosing Options:
- Regular dose: 500 mg (amoxicillin component) orally twice daily 2
- Higher dose: 875 mg (amoxicillin component) orally twice daily 1, 3
- High-dose: 2000/125 mg (Augmentin XR) twice daily for resistant respiratory pathogens 4
- IV formulation: 1 g amoxicillin plus 200 mg clavulanic acid every 8 hours 5
Specific Infection Types:
- Respiratory tract infections: 875/125 mg twice daily for 5-7 days 1, 2
- Sinusitis: 875/125 mg twice daily for 5-7 days 1
- Skin/soft tissue infections: 875/125 mg twice daily for 7-10 days 2
- Urinary tract infections: 500/125 mg three times daily 6
Pediatric Dosing
Standard Dosing Options:
- Regular dose: 22.5-45 mg/kg/day of amoxicillin component divided twice daily 1
- High-dose: 90 mg/kg/day of amoxicillin component divided twice daily (Augmentin ES-600) for resistant pathogens 4
Specific Infection Types:
- Respiratory infections: 45 mg/kg/day divided twice daily 1
- Sinusitis: 90 mg/kg/day divided twice daily for 10-14 days 1
- Otitis media (persistent/recurrent): 90/6.4 mg/kg/day divided twice daily 4
- H. influenzae infections: 45 mg/kg/day in 3 doses or 90 mg/kg/day in 2 doses 1
Dosing Considerations
Duration of Therapy:
- Adults: 5-7 days for uncomplicated infections 1
- Children: 10-14 days for most infections 1
- Minimum duration: 7-10 days for mild infections 2
- Moderate infections: 10-14 days 2
Renal Dosing Adjustments:
- Dose adjustment required for patients with renal impairment 2
- For severe renal impairment, reduce dosing frequency rather than dose amount
Special Populations:
- Elderly: Consider reduced dosing (similar to renal impairment)
- Pregnancy: Category B - generally considered safe 1
- Nursing mothers: Use with caution as drug is distributed in milk 1
Clinical Pearls
- Amoxicillin-clavulanate is preferred over amoxicillin alone for infections likely to involve β-lactamase-producing organisms 1, 4
- Take with food to reduce gastrointestinal side effects
- Diarrhea is common (approximately 40% of patients) regardless of dosing 3
- The 875 mg tablet is not equivalent to two 500 mg tablets due to different clavulanate content
- For IV to oral conversion, transition to equivalent oral dosing when clinically improved 5
Common Pitfalls to Avoid
- Using amoxicillin-clavulanate as monotherapy for MRSA infections (not recommended) 1
- Underdosing for suspected resistant S. pneumoniae infections
- Failing to adjust dosing in renal impairment
- Not completing the full course of therapy, particularly in children
- Confusing different formulations (ES-600, XR) with standard formulations
Amoxicillin-clavulanate remains a cornerstone antibiotic for community-acquired infections due to its broad spectrum of activity against both gram-positive and β-lactamase-producing organisms 4.