What is the appropriate dosing schedule for Augmentin (amoxicillin-clavulanate) in a patient with Impaired renal function (dialysis) and a urinary tract infection (UTI)?

Dosing of Augmentin (Amoxicillin-Clavulanate) in a Dialysis Patient with UTI

For a patient on dialysis with a UTI, Augmentin 500mg should be given every 24 hours, administered after the dialysis session. 1

Dosing Considerations in Renal Impairment

• The FDA label for amoxicillin-clavulanate specifically states that patients with a glomerular filtration rate less than 10 mL/min (which includes dialysis patients) should receive 500 mg/125 mg or 250 mg/125 mg every 24 hours, depending on the severity of the infection 1
• Hemodialysis patients should receive an additional dose both during and at the end of dialysis to replace what is removed during the procedure 1
• Medications for dialysis patients should be administered after the dialysis session to prevent premature removal of the drug 2

Administration Schedule

• For a patient on dialysis with a UTI, the appropriate dosing schedule is:
  • Augmentin 500mg once daily (every 24 hours) 1
  • The medication should be given after the dialysis session on dialysis days 2
  • On non-dialysis days, the medication should still be given once daily 1

Rationale for Modified Dosing in Dialysis

• Standard dosing of antibiotics (such as the typical three-times-daily regimen for Augmentin) is inappropriate for patients with end-stage renal disease as it can lead to drug accumulation and toxicity 2
• The interval between drug doses in patients with a creatinine clearance of <30 mL/minute and those receiving hemodialysis should be increased rather than decreasing the dose 2
• While amoxicillin and clavulanic acid are primarily metabolized by the liver, reduced renal function affects clearance, necessitating adjusted dosing schedules 1

Duration of Therapy

• For complicated UTIs, the recommended duration of treatment is typically 7-14 days, though this may need to be individualized based on clinical response 3
• Monitor for clinical improvement and resolution of symptoms to determine if the full course of therapy is needed 4

Common Pitfalls to Avoid

• Do not administer the medication before dialysis as this would lead to premature removal of the drug and subtherapeutic levels 2
• Do not use the standard three-times-daily dosing as this would lead to drug accumulation and potential toxicity in dialysis patients 1
• Be aware that the 250 mg/125 mg and 500 mg/125 mg tablets contain the same amount of clavulanic acid (125 mg), so the choice between them depends on the severity of the infection 1
• Monitor for adverse effects, particularly gastrointestinal symptoms, which may be more common in patients with renal impairment 4

Remember that proper dosing of antibiotics in dialysis patients is crucial to ensure both efficacy against the infection and prevention of drug-related toxicity.