Augmentin Dosing for CKD Stage IIIb Patients
For patients with Chronic Kidney Disease (CKD) stage IIIb (GFR 30-44 mL/min), Augmentin (amoxicillin/clavulanate) should be dosed at 375 mg twice daily instead of the standard three times daily regimen to prevent drug accumulation and potential toxicity.
Dosing Considerations in CKD
- CKD stage IIIb represents moderate to severe renal impairment with GFR between 30-44 mL/min, requiring dose adjustment for renally cleared medications 1
- Both amoxicillin and clavulanic acid are primarily eliminated by the kidneys, with prolonged half-lives in patients with reduced renal function 2
- Inappropriate dosing in CKD patients can lead to drug accumulation, increased adverse drug events, and potentially worse clinical outcomes 3
Specific Dosing Recommendations
For CKD stage IIIb (GFR 30-44 mL/min):
For more severe renal impairment (GFR <30 mL/min):
Clinical Considerations
- Monitor for signs of adverse effects even with adjusted dosing, particularly gastrointestinal symptoms 4
- For serious infections requiring higher drug exposure, consider monitoring drug levels if available 3
- Hemodialysis can remove significant amounts of both amoxicillin and clavulanic acid (approximately 65% during a standard session), potentially requiring supplemental dosing post-dialysis 2
Common Pitfalls to Avoid
- Failing to adjust antibiotic doses in CKD patients - studies show up to 53% of prescriptions for CKD patients may not comply with renal dosing guidelines 3
- Using standard dosing in CKD patients can lead to drug accumulation and increased adverse effects 3
- Conversely, excessive dose reduction may lead to subtherapeutic levels and treatment failure 5
- Not accounting for the impact of dialysis on drug clearance when applicable 2