What is the recommended dosing for Augmentin (amoxicillin/clavulanate) for the treatment of sinus infection?

Augmentin Dosing for Sinus Infection

For adults with sinus infection, the recommended dose of Augmentin is 875 mg amoxicillin/125 mg clavulanate twice daily for 10-14 days. 1, 2

Initial Treatment Options

• For mild sinus infections in adults who have not received antibiotics in the previous 4-6 weeks, recommended options include:

  • Amoxicillin/clavulanate (Augmentin) 875/125 mg twice daily 3, 1
  • Amoxicillin 1.5-4 g/day 3
  • Alternative cephalosporins (cefpodoxime proxetil, cefuroxime axetil, or cefdinir) 3

• For patients with β-lactam allergies, alternative options include TMP/SMX, doxycycline, azithromycin, or clarithromycin, though these have higher bacteriologic failure rates (20-25%) 3

Dosing for Moderate or Recent Antibiotic Use

• For adults with moderate disease or who have received antibiotics in the previous 4-6 weeks, high-dose amoxicillin/clavulanate (4 g/250 mg per day) is recommended 3, 1
• This higher dose is particularly important in areas with high prevalence of resistant S. pneumoniae 2

Treatment Duration

• Standard treatment duration is 10-14 days 1, 2
• Some clinicians recommend continuing treatment until the patient has been symptom-free for 7 days 2
• Short-course therapy (5 days) has been studied but may not be appropriate for patients with risk factors such as recurrent sinusitis or previous surgical sinus drainage 4

Dosing Schedule

• The twice-daily regimen (875/125 mg) has been shown to be as effective as the three-times-daily regimen (500/125 mg) 5, 6
• The twice-daily dosing may improve patient adherence due to convenience 6

Monitoring Response

• Patients should be evaluated after 72 hours of treatment 3
• If not improving or worsening after 72 hours, consider switching to an alternative antibiotic therapy or reevaluating the diagnosis 3

Important Clinical Considerations

• Antibiotics should only be prescribed for bacterial sinusitis; viral upper respiratory infections should not be treated with antibiotics 3, 2
• Recent research suggests that high-dose amoxicillin/clavulanate may not provide additional benefit over standard-dose for most adults with acute sinusitis 7
• Common adverse effects include diarrhea, nausea, and abdominal pain 8, 7

Common Pitfalls to Avoid

• Treating viral sinusitis with antibiotics is inappropriate and contributes to antibiotic resistance 3, 2
• Not completing the full course of antibiotics can lead to incomplete eradication and potential relapse 2
• Using standard-dose amoxicillin in areas with high resistance patterns may lead to treatment failure 2