What is the dose of Augmentin (amoxicillin/clavulanate) for a cough and cold?

Augmentin Dosing for Cough and Cold

Antibiotics including Augmentin (amoxicillin/clavulanate) are generally not recommended for routine treatment of cough and cold symptoms as these are typically viral in origin and antibiotics will not provide benefit while increasing risk of side effects.

Understanding Cough and Cold Etiology

Most cough and cold symptoms are caused by viral infections that do not respond to antibiotics. The evidence shows:

• Acute bronchitis, a common cause of cough with cold symptoms, typically does not require antibiotic therapy 1
• Antibiotics have not shown consistent benefit for uncomplicated respiratory infections 1
• Cough associated with common cold is often related to upper respiratory tract stimuli rather than bacterial infection 2

When Augmentin May Be Considered

Augmentin should only be prescribed in specific circumstances when bacterial infection is suspected:

1. Severe acute purulent sinusitis (Grade C evidence) 1
2. Persistent symptoms with risk factors such as:
   • Patients with asthma, heart disease, or other underlying conditions 1
   • Failure of symptomatic treatment 1
   • Evidence of bacterial pathogens (H. influenzae, M. catarrhalis, S. pneumoniae) 3

Appropriate Dosing When Indicated

For Adults:

• Standard dose: 500 mg/125 mg every 12 hours or 250 mg/125 mg every 8 hours
• For more severe respiratory infections: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 4

For Children:

• Based on amoxicillin component:
  • Age 3 months and older: 45 mg/kg/day divided every 12 hours (preferred) or 40 mg/kg/day divided every 8 hours 4
  • For sinusitis: 80 mg/kg/day in three doses, not exceeding 3 g/day 1

Duration of Treatment

When Augmentin is indicated for a bacterial respiratory infection:

• Standard duration: 7-10 days 1, 4
• Some formulations (cefuroxime-axetil and cefpodoxime-proxetil) have shown efficacy in 5 days 1

Important Considerations and Cautions

• Take with food: Augmentin should be taken at the start of a meal to minimize gastrointestinal intolerance 4
• Antibiotic resistance: Overuse of antibiotics contributes to resistance development 5
• Side effects: Common side effects include diarrhea, nausea, and rash
• Alternative treatments: For symptomatic relief of cough and cold:
  • Antihistamine-decongestant combinations may reduce cough severity 2
  • Dextromethorphan may provide symptomatic relief for cough 6
  • First-dose nasal decongestants may provide temporary relief 6

Clinical Decision Algorithm

1. Assess duration and severity of symptoms

   • If <3 weeks with no complications: likely viral, avoid antibiotics 1
   • If severe symptoms or >3 weeks: consider further evaluation

2. Check for bacterial infection indicators:

   • Fever >38°C
   • Purulent nasal discharge
   • Facial pain/pressure
   • Worsening symptoms after initial improvement

3. Consider patient risk factors:

   • Underlying conditions (asthma, COPD, immunocompromise)
   • Recent antibiotic use
   • Age (very young or elderly)

4. Treatment decision:

   • No indicators of bacterial infection: symptomatic treatment only
   • Clear indicators of bacterial infection or high-risk patient with persistent symptoms: consider Augmentin at appropriate dose

Remember that inappropriate antibiotic use contributes to resistance, side effects, and does not improve outcomes for viral infections.