Augmentin (Amoxicillin/Clavulanate) Dosing for Pneumonia
For adults with pneumonia, the recommended dose of Augmentin is 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for more severe infections and respiratory tract infections. 1
Standard Dosing for Adults with Normal Renal Function
Outpatient Treatment
- For outpatients with comorbidities (chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia):
- Amoxicillin/clavulanate 875 mg/125 mg twice daily OR
- Amoxicillin/clavulanate 500 mg/125 mg three times daily 2
Inpatient Treatment
- For non-severe inpatient pneumonia: β-lactam (including amoxicillin/clavulanate) plus a macrolide or respiratory fluoroquinolone 2
- For severe inpatient pneumonia: β-lactam plus a macrolide or β-lactam plus a fluoroquinolone 2
Dosing in Renal Impairment
The FDA-approved label does not provide specific dosing adjustments for renal impairment for Augmentin 1. However, clinical practice guidelines suggest:
- For GFR 10-80 mL/min: No dosage adjustment needed 3
- For severe renal impairment (GFR <10 mL/min): Use caution as AUC increases by 35% 3
Administration Considerations
- Take Augmentin at the start of a meal to enhance absorption of clavulanate potassium and minimize gastrointestinal intolerance 1
- Two 250 mg/125 mg tablets should not be substituted for one 500 mg/125 mg tablet, as they contain the same amount of clavulanic acid 1
Treatment Duration
- Patients should be afebrile for 48-72 hours and have no more than one pneumonia-associated sign of clinical instability before discontinuing therapy 3
- Clinical improvement typically includes reduction in fever, improvement in respiratory symptoms, and stabilization of vital signs 3
Special Considerations
Formulation Selection
- The standard formulations (875/125 mg twice daily or 500/125 mg three times daily) are appropriate for most community-acquired pneumonia cases 2, 1
- In areas with high prevalence of drug-resistant S. pneumoniae, consider high-dose formulations:
- Augmentin XR (2000/125 mg twice daily) for adults 4
Combination Therapy
- For patients with comorbidities, consider combination therapy with a β-lactam (including amoxicillin/clavulanate) plus a macrolide 2, 3
- For severe pneumonia, the preferred regimen is a β-lactam plus a macrolide 3
Common Pitfalls and Caveats
Dosing errors: Ensure correct dosing based on the specific formulation. Different formulations contain different amounts of clavulanic acid and are not interchangeable 1
Timing of administration: Always administer with food to minimize gastrointestinal side effects and enhance absorption 1
Resistance considerations: In areas with high prevalence of resistant pneumococci, higher doses may be needed 4
Combination therapy: For patients with comorbidities or severe pneumonia, monotherapy with amoxicillin/clavulanate is not recommended; combination therapy with a macrolide or fluoroquinolone is preferred 2, 3
Renal function: While specific guidance is limited, use caution in severe renal impairment 3