Augmentin Dosing for Upper and Lower Respiratory Infections
For respiratory infections, Augmentin (amoxicillin/clavulanate) should be dosed at 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for adults, and 80-100 mg/kg/day of the amoxicillin component in three divided doses for children under 3 years. 1
Adult Dosing
- For upper respiratory tract infections (including acute otitis media and sinusitis), the recommended dose is 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for 7-10 days 1
- For lower respiratory tract infections (including community-acquired pneumonia), the same dosing regimen of 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours is recommended 1
- Treatment duration should typically be 7-10 days for most respiratory infections in adults 1
- To minimize gastrointestinal intolerance, Augmentin should be taken at the start of a meal 2
Pediatric Dosing
- For children under 3 years with lower respiratory infections, the recommended dose is 80-100 mg/kg/day of the amoxicillin component in three divided doses 3
- For children with acute otitis media, Augmentin 600 mg/42.9 mg per 5 mL formulation should be dosed at 90 mg/kg/day divided every 12 hours for 10 days 2
- For children 3-5 years, amoxicillin-clavulanate (80 mg/kg/day amoxicillin component) is justified when there is insufficient vaccination against H. influenzae type b or coexistence of purulent acute otitis media 3
- Treatment duration should be 8-10 days for children under 2 years and 5 days for older children with acute otitis media 3
Specific Respiratory Infections
Upper Respiratory Infections
- For acute otitis media in children under 2 years, antibiotic therapy is recommended; for children over 2 years, antibiotics should be reserved for cases with marked symptoms (high fever, intense earache) 3
- In otitis associated with purulent conjunctivitis (likely H. influenzae infection), amoxicillin-clavulanate is indicated 3
- For febrile painful otitis (likely pneumococcal infection), amoxicillin may be sufficient, but amoxicillin-clavulanate provides broader coverage against potential H. influenzae 3
Lower Respiratory Infections
- For community-acquired pneumonia in adults, amoxicillin-clavulanate provides coverage against both S. pneumoniae and beta-lactamase-producing pathogens 4
- For acute bronchitis in children with high fever (>38.5°C) persisting for more than 3 days, amoxicillin-clavulanate is appropriate 3
- For community-acquired pneumonia in children under 3 years, amoxicillin is typically sufficient unless there's concern for beta-lactamase-producing organisms 3
- Augmentin has shown a clinical cure rate of 88.4% in serious respiratory infections 5
Clinical Pearls and Pitfalls
- Therapeutic efficacy should be assessed after 2-3 days of treatment; if no improvement is observed, clinical and radiological reassessment is necessary 3
- Failure of amoxicillin-clavulanate after 48 hours may suggest atypical pathogens, which would require consideration of macrolide therapy 3
- The pharmacokinetically enhanced formulation (Augmentin XR) provides better coverage against S. pneumoniae with reduced susceptibility to penicillin 4
- For bacteriological efficacy, Augmentin may be superior to amoxicillin alone in respiratory infections with gram-negative organisms 6
- A short course (3-day) of azithromycin has been shown to be as effective as a 10-day course of Augmentin for lower respiratory tract infections, which may be considered in patients with compliance issues 7
- Augmentin should be prepared as a suspension at the time of dispensing by adding the appropriate amount of water and shaking vigorously 2