What is the dose of Augmentin (amoxicillin/clavulanate) for a urinary tract infection (UTI)?

Dosage of Amoxicillin/Clavulanate (Augmentin) for Urinary Tract Infections

For urinary tract infections, amoxicillin-clavulanate should be dosed at 20-40 mg/kg per day in 3 divided doses for children, or 375 mg three times daily for adults. 1

Adult Dosing Recommendations

Uncomplicated UTIs

• Standard adult dose: 375 mg (250 mg amoxicillin/125 mg clavulanic acid) three times daily for 3-5 days 2, 3
• Alternative dosing: 500/125 mg three times daily for more resistant infections 4

Complicated UTIs

• Standard adult dose: 500/125 mg three times daily for 7-10 days 2, 5
• Duration should be 7-14 days for more severe or complicated infections 1, 2

Pediatric Dosing

• Children: 20-40 mg/kg per day divided into 3 doses 1
• Duration: 7-14 days depending on severity 1

Clinical Considerations

Efficacy

• Amoxicillin-clavulanate is particularly effective for UTIs caused by amoxicillin-resistant organisms, with success rates of approximately 70-84% 6, 3
• The addition of clavulanic acid reduces resistance in most Gram-negative urinary pathogens 6
• Particularly valuable for treating multiply resistant bacteria in UTIs 6

Timing of Administration

• Should be taken at the start of a meal to minimize gastrointestinal side effects 4
• Doses should be evenly spaced throughout the day (approximately every 8 hours) 3

Monitoring and Follow-up

• Urine culture and susceptibility testing should be obtained before initiating therapy 2
• Clinical improvement should be expected within 24-48 hours 1
• Follow-up urine culture may be considered 1-2 weeks after completion of therapy to confirm eradication 3

Important Considerations

Antimicrobial Stewardship

• While effective, amoxicillin-clavulanate should be selected based on local resistance patterns 2
• Fluoroquinolones and other broad-spectrum antibiotics should be reserved for more serious infections when other agents cannot be used 1

Common Pitfalls to Avoid

1. Underdosing: Insufficient dosing may lead to treatment failure, especially with resistant organisms
2. Inappropriate duration: Too short a course may lead to recurrence, while unnecessarily long courses contribute to resistance
3. Failure to consider local resistance patterns: Always consider local antimicrobial susceptibility data when selecting therapy
4. Treating asymptomatic bacteriuria: Avoid treating asymptomatic bacteriuria in most populations as it does not improve outcomes 2
5. Not adjusting for renal function: Dose adjustment may be necessary in patients with significant renal impairment

Side Effects

• Gastrointestinal side effects (diarrhea, nausea) occur in approximately 20% of patients but are typically mild 3
• Taking with food can help minimize GI side effects 4

Amoxicillin-clavulanate remains an effective option for UTIs, particularly for infections caused by resistant organisms when other first-line agents cannot be used or have failed.