What is the recommended dose of Augmentin (amoxicillin-clavulanate) for adults and children?

Recommended Dosage of Augmentin (Amoxicillin-Clavulanate)

For adults, the standard dose of Augmentin is 875 mg/125 mg twice daily or 500 mg/125 mg every 8 hours, with higher doses for severe infections. For children, the recommended dose is 25-45 mg/kg/day of the amoxicillin component divided in two doses for mild-moderate infections, or 40-45 mg/kg/day divided in two doses for severe infections. 1, 2

Adult Dosing

Standard Dosing Options:

• 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

Special Formulations:

• Augmentin XR: 2000 mg/125 mg twice daily (for respiratory infections with drug-resistant pathogens) 3

Pediatric Dosing

Based on Weight and Severity:

• Children ≥3 months and <40 kg:

  • Mild to moderate infections: 25 mg/kg/day of amoxicillin component divided every 12 hours OR 20 mg/kg/day divided every 8 hours 2
  • Severe infections: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 2

• Children ≥3 months and ≥40 kg: Use adult dosing 1

• Children <3 months: Maximum 30 mg/kg/day divided every 12 hours due to immature renal function 2

• Augmentin ES-600: 90/6.4 mg/kg/day in two divided doses (for pediatric persistent/recurrent acute otitis media) 4

Dosing in Special Populations

Renal Impairment:

• GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours (based on infection severity) 1, 2
• GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours (based on infection severity) 1, 2
• Hemodialysis patients: 500 mg/125 mg or 250 mg/125 mg every 24 hours with additional dose during and after dialysis 2
• Severely impaired patients (GFR <30 mL/min): Should NOT receive 875 mg/125 mg formulation 2

Hepatic Impairment:

• Dose with caution and monitor hepatic function regularly 1

Administration Guidelines

• Take at the start of a meal to minimize gastrointestinal intolerance and enhance clavulanate absorption 1, 2
• Continue treatment for at least 48-72 hours after patient becomes asymptomatic 2
• For Streptococcus pyogenes infections, treat for at least 10 days to prevent acute rheumatic fever 2

Important Considerations

• Two 250 mg/125 mg tablets are NOT equivalent to one 500 mg/125 mg tablet (same clavulanate content but different amoxicillin content) 1
• For H. influenzae infections, amoxicillin-clavulanate is effective against β-lactamase producing strains 5
• Treatment duration should typically be 5-10 days depending on the infection type and severity 6

Common Pitfalls to Avoid

1. Dosing errors: Not recognizing that different formulations have different amoxicillin-to-clavulanate ratios
2. Renal function: Failing to adjust dose in patients with impaired renal function
3. Administration timing: Not giving with food, which can increase gastrointestinal side effects
4. Duration: Not treating long enough, especially for streptococcal infections
5. Formulation selection: Using standard formulations for resistant pathogens when enhanced formulations may be needed

By following these dosing guidelines, you can optimize the effectiveness of Augmentin while minimizing potential adverse effects.