What is the appropriate dosing regimen for Augmentin (amoxicillin/clavulanate) in treating upper and lower respiratory infections?

Augmentin Dosing for Upper and Lower Respiratory Infections

For upper and lower respiratory infections in adults, Augmentin (amoxicillin/clavulanate) should be dosed at 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for 7-10 days, with the twice-daily regimen preferred due to fewer gastrointestinal side effects. 1, 2

Adult Dosing

Standard Dosing

• For mild infections in adults who have not received antibiotics in the previous 4-6 weeks:
  • 875 mg/125 mg every 12 hours OR
  • 500 mg/125 mg every 8 hours 2
• Duration: 7-10 days for most respiratory infections 2, 3

High-Dose Regimen

• For more severe infections or when there is concern for resistant pathogens:
  • 2000 mg/125 mg (Augmentin XR) twice daily 4, 5
• Particularly useful in areas with high prevalence of drug-resistant S. pneumoniae 5

Special Considerations

• For adults who have received antibiotics in the previous 4-6 weeks or with moderate disease:
  • High-dose amoxicillin/clavulanate (4 g/250 mg per day) may be considered 2
• The twice-daily regimen (every 12 hours) is associated with significantly less diarrhea than the three-times-daily regimen 1

Pediatric Dosing

Children Under 3 Years

• For pneumonia and lower respiratory infections:
  • 80-100 mg/kg/day of amoxicillin component in three divided doses for children weighing less than 30 kg 2
• For bronchiolitis with high fever (>38.5°C) persisting more than 3 days:
  • Amoxicillin-clavulanate is appropriate 2

Children 3-5 Years

• Standard dosing: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1
• For more severe infections: 90 mg/kg/day of amoxicillin component divided in two doses 1
• Amoxicillin-clavulanate (80 mg/kg/day amoxicillin component) is justified when there is:
  • Insufficient vaccination against H. influenzae type b
  • Coexistence of purulent acute otitis media 2

Children Over 5 Years and Weighing 40 kg or More

• Should be dosed according to adult recommendations 1

Specific Respiratory Infections

Upper Respiratory Tract Infections (URTI)

• For acute bacterial rhinosinusitis:
  • Adults: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 2
  • Children: 90 mg/6.4 mg/kg/day in two divided doses for recurrent or persistent infections 4
• Duration: 7-10 days 3

Lower Respiratory Tract Infections (LRTI)

• For community-acquired pneumonia:
  • Adults: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 2
  • Children: 80-100 mg/kg/day of amoxicillin component in three divided doses 2
• For acute exacerbations of chronic bronchitis:
  • 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 2, 6
• Duration: 7-10 days for most infections; 14 days for atypical pneumonia 2

Clinical Pearls and Pitfalls

• Assessment of response: Evaluate therapeutic efficacy after 2-3 days of treatment. If no improvement is observed, consider alternative antibiotics or reevaluation 2
• Beta-lactam allergies: In patients with immediate Type I hypersensitivity reactions, alternative antibiotics should be considered, though bacterial failure rates of 20-25% are possible with non-beta-lactam alternatives 2
• Resistance concerns: In areas with high prevalence of resistant S. pneumoniae, higher doses of amoxicillin/clavulanate may be necessary 4, 5
• Administration: Should be taken with food to minimize gastrointestinal side effects 7
• Hepatic impairment: Patients with hepatic impairment should be dosed with caution and have hepatic function monitored regularly 1

By following these dosing recommendations, Augmentin can effectively treat both upper and lower respiratory tract infections while minimizing the risk of treatment failure and adverse effects.