What is the recommended dosing of Augmentin (amoxicillin-clavulanate) for the treatment of sinusitis?

Augmentin (Amoxicillin-Clavulanate) Dosing for Sinusitis

For sinusitis treatment, high-dose amoxicillin-clavulanate (875/125 mg twice daily for 10-14 days) is recommended as the optimal dosing regimen, especially for patients who have not responded to initial amoxicillin therapy or in regions with high antibiotic resistance. 1

Initial Treatment Approach

• Amoxicillin is typically the first-line antibiotic for uncomplicated sinusitis, with a recommended treatment duration of 10-14 days 1
• For patients who fail to improve after 3-5 days of amoxicillin therapy, switching to high-dose amoxicillin-clavulanate is recommended 1

Specific Augmentin Dosing Recommendations

Standard Dosing

• For adults with sinusitis:
  • 875/125 mg twice daily for 10-14 days 1, 2
  • Alternative: 500/125 mg three times daily for 10-14 days 1, 3

High-Dose Regimen

• For patients with suspected resistant organisms or treatment failure:
  • 90 mg/kg amoxicillin and 6.4 mg/kg clavulanate (not to exceed 2 g every 12 hours) 1

Treatment Duration

• Standard course: 10-14 days 1
• Continue treatment until the patient is well for 7 days after symptom resolution 1
• Some physicians continue treatment until the patient is improved symptomatically to near normal 1

Clinical Considerations

When to Use High-Dose Augmentin

• Poor response to initial amoxicillin therapy 1
• Regions with high incidence of antibiotic resistance 1
• Suspected resistant pathogens 1

Advantages of Twice-Daily Dosing

• The twice-daily 875/125 mg regimen has shown at least equivalent or superior pharmacokinetics and tissue penetration compared to the three-times-daily 500/125 mg regimen 4
• Better patient compliance with fewer daily doses 2
• Similar clinical success rates between twice-daily and three-times-daily dosing (93% vs 88%) 2

Monitoring Response

• Evaluate improvement of signs and symptoms after 3-5 days of treatment 1
• If symptoms are improving, continue treatment until the patient is well for 7 days 1
• If minimal or no improvement after 3-5 days, consider switching to a different antibiotic 1

Common Pitfalls and Caveats

• Diarrhea is the most common adverse event with amoxicillin-clavulanate therapy 1
• The higher dose of amoxicillin in the 875/125 mg formulation helps overcome resistance while maintaining the same amount of clavulanic acid, potentially reducing gastrointestinal side effects 4
• Ensure patients complete the full course of antibiotics to prevent relapse, even if symptoms improve before completion 1
• For patients allergic to or intolerant of amoxicillin-clavulanate, alternatives include cephalosporins, macrolides, or quinolones 1

Treatment Response Assessment

• Partial response: Patient is symptomatically improved but not back to normal at the end of the first course of antibiotics - continue treatment for another 10-14 days 1
• Poor response: Little or no symptomatic improvement after the first course - switch to a broader-spectrum antibiotic 1