What is the recommended dose and duration of Augmentin (amoxicillin/clavulanate) for a patient with a urinary tract infection (UTI) and potential impaired renal function?

Augmentin Dosing for UTI in Patients with Impaired Renal Function

For patients with UTI and impaired renal function, Augmentin (amoxicillin/clavulanate) should be dosed at 500 mg/125 mg every 12 hours or 250 mg/125 mg every 24 hours, depending on the severity of renal impairment and infection. 1, 2

Dosing Based on Renal Function

Normal to Moderate Renal Impairment

• For patients with normal renal function or mild impairment (GFR >30 mL/min):
  • 500 mg/125 mg every 12 hours for mild/moderate infections 1, 2
  • 875 mg/125 mg every 12 hours for severe infections 1, 2

Severe Renal Impairment

• For patients with GFR 10-30 mL/min:
  • 500 mg/125 mg or 250 mg/125 mg every 12 hours, depending on infection severity 1, 2
• For patients with GFR <10 mL/min:
  • 500 mg/125 mg or 250 mg/125 mg every 24 hours, depending on infection severity 1, 2
• Patients on hemodialysis:
  • 500 mg/125 mg or 250 mg/125 mg every 24 hours 2
  • Additional dose should be administered both during and at the end of dialysis 1, 2

Duration of Treatment

• Standard duration for UTI treatment is 7 days 3
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 1
• For complicated UTIs or in patients with impaired renal function, a 10-day course may be appropriate to ensure complete bacterial eradication 3, 4

Administration Guidelines

• Augmentin should be taken at the start of a meal to enhance absorption of clavulanic acid and minimize gastrointestinal intolerance 2
• For patients unable to swallow tablets, oral suspension can be prepared according to package instructions 1

Special Considerations for Renal Patients

• Patients with severely impaired renal function (GFR <30 mL/min) should NOT receive the 875 mg/125 mg formulation 1, 2
• Monitoring of renal function is recommended during treatment 5
• Hepatically impaired patients should be dosed with caution and hepatic function monitored at regular intervals 2

Clinical Efficacy in UTI

• Augmentin has demonstrated success rates of approximately 70% for amoxicillin-resistant organisms in UTIs 6
• For recurrent UTIs, clinical studies have shown microbiological cure rates of 84% one week after treatment and 67% one month later 3

Potential Side Effects and Monitoring

• Monitor for gastrointestinal side effects, which occur in approximately 20% of patients but are generally mild 3
• In patients with renal impairment, monitor for signs of drug accumulation 7
• Consider baseline and periodic assessment of renal and hepatic function during treatment 5

Pitfalls to Avoid

• Avoid excessive accumulation of the drug by adhering to recommended dosing intervals based on renal function 5
• Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain different ratios of amoxicillin to clavulanic acid 2
• Patients on hemodialysis require supplemental dosing during and after dialysis sessions to maintain therapeutic levels 2, 7

Remember that proper dosing of Augmentin in patients with impaired renal function is essential to balance efficacy against the risk of drug accumulation and toxicity.