What is the recommended dose of Augmentin (amoxicillin-clavulanate) for treating acute bacterial sinusitis?

Recommended Augmentin Dosage for Acute Bacterial Sinusitis

For adults with acute bacterial sinusitis, the recommended dose of Augmentin (amoxicillin-clavulanate) is 875/125 mg twice daily for 5-7 days as first-line therapy, with high-dose Augmentin of 2000 mg (amoxicillin component) with 125 mg clavulanate twice daily recommended for patients with risk factors for resistant pathogens. 1

Adult Dosing Recommendations

Standard-Dose Therapy

• 875 mg amoxicillin/125 mg clavulanate twice daily for 5-7 days 1
• Appropriate for patients with:
  • Mild disease
  • No recent antibiotic use in past 4-6 weeks
  • No risk factors for resistant pathogens

High-Dose Therapy

• 2000 mg amoxicillin/125 mg clavulanate twice daily for 5-7 days 1
• Indicated for patients with:
  • Recent antibiotic use (past 4-6 weeks)
  • Moderate disease severity
  • Risk factors for penicillin-resistant S. pneumoniae 2
  • Age >65 years
  • Immunocompromised status
  • Significant comorbidities
  • Residence in areas with high prevalence of resistant pathogens 1

Pediatric Dosing Recommendations

• High-dose amoxicillin/clavulanate (90 mg/6.4 mg per kg per day) 2
• Typically divided into two doses per day
• Duration of 5-7 days for uncomplicated cases 1

Clinical Considerations

When to Use High-Dose Therapy

High-dose therapy should be considered when:

• Patient has received antibiotics in the previous 4-6 weeks
• Patient has moderate disease severity
• Patient has risk factors for drug-resistant S. pneumoniae 2

Efficacy Considerations

Recent research has shown mixed results regarding the superiority of high-dose versus standard-dose amoxicillin-clavulanate:

• A 2018 study found that immediate-release high-dose amoxicillin-clavulanate showed an 18% greater improvement at day 3 compared to standard dose, though with increased risk of severe diarrhea 3
• However, a more recent 2021 study found no significant benefit of high-dose over standard-dose therapy (44.3% vs 36.4% improvement at day 3) 4

Monitoring and Side Effects

• Assess for clinical improvement within 72 hours of starting antibiotics
• Consider switching to a broader-spectrum antibiotic if no improvement is seen
• Monitor for gastrointestinal side effects, which are common with Augmentin
• Severe diarrhea may be more common with high-dose therapy (7-15.8%) compared to standard-dose (4.8-7%) 3, 4

Alternative Options for Penicillin-Allergic Patients

For patients with true penicillin allergy:

• Respiratory fluoroquinolones (levofloxacin 500 mg once daily or moxifloxacin 400 mg once daily)
• Doxycycline
• Clindamycin plus rifampin (for severe cases) 2, 1

Treatment Failure

If no improvement after 72 hours of therapy:

1. Consider switching to a broader-spectrum antibiotic
2. Reevaluate the diagnosis
3. Consider imaging (CT scan) or specialist referral
4. Consider complications requiring surgical intervention 2, 1

Remember that proper patient selection for high-dose therapy is crucial to balance the benefits of improved coverage against resistant pathogens with the increased risk of adverse effects.