What is the recommended use and dosage of Augmentin (amoxicillin/clavulanate) for treating bacterial infections?

Recommended Use and Dosage of Augmentin (Amoxicillin/Clavulanate) for Bacterial Infections

Augmentin (amoxicillin/clavulanate) is a broad-spectrum antibiotic recommended for treating various bacterial infections at specific dosages based on infection type, severity, and patient characteristics.

Adult Dosing Recommendations

Standard Dosing for Common Infections

• For mild to moderate infections (ear/nose/throat, skin/skin structure, genitourinary tract): 500 mg every 12 hours or 250 mg every 8 hours 1
• For severe infections (ear/nose/throat, skin/skin structure, genitourinary tract): 875 mg every 12 hours or 500 mg every 8 hours 1
• For lower respiratory tract infections (mild/moderate or severe): 875 mg every 12 hours or 500 mg every 8 hours 1

Special Indications

• For animal bite infections: Amoxicillin-clavulanate 875/125 mg twice daily orally 2
• For human bite infections: Amoxicillin-clavulanate 875/125 mg twice daily orally 2
• For H. pylori infection (with duodenal ulcer):
  • Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily for 14 days 1
  • Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily for 14 days 1

Pediatric Dosing Recommendations

Standard Dosing

• For children ≥3 months and <40 kg:

  • Mild/moderate infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 1
  • Severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1
  • Lower respiratory tract infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1

• For children <12 weeks (3 months): Maximum 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 1

Special Indications

• For acute bacterial rhinosinusitis: Amoxicillin/clavulanate (90 mg/6.4 mg/kg per day) 2
• For recurrent acute otitis media: Amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses 3

Duration of Treatment

• Treatment should continue for a minimum of 48 to 72 hours beyond symptom resolution or evidence of bacterial eradication 1
• For Streptococcus pyogenes infections: Minimum 10 days to prevent acute rheumatic fever 1
• For H. pylori eradication: 14 days 1
• For skin and soft tissue infections: 5-7 days after clinical improvement 2
• For animal or human bite infections: 5-7 days 2

Dosing in Renal Impairment

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours, depending on infection severity 1
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours, depending on infection severity 1
• Hemodialysis: 500 mg or 250 mg every 24 hours with additional dose during and at end of dialysis 1
• Patients with severe renal impairment (GFR <30 mL/min) should NOT receive the 875 mg dose 1

Administration Guidelines

• Take at the start of a meal to minimize gastrointestinal intolerance 1
• For oral suspension:
  • Reconstitute with appropriate amount of water
  • Shake well before using
  • Discard any unused portion after 14 days
  • Refrigeration preferred but not required 1

Common Indications

Respiratory Tract Infections

• Community-acquired pneumonia: Amoxicillin/clavulanate 1.2 g IV every 8 hours (for moderate severity) 2
• Acute bacterial rhinosinusitis: Amoxicillin/clavulanate (90 mg/6.4 mg/kg per day) for children 2

Skin and Soft Tissue Infections

• For animal or human bite infections: Amoxicillin-clavulanate 875/125 mg twice daily 2
• For surgical site infections: Amoxicillin/clavulanate is appropriate when the operation involved intestinal tract or female genitalia 2

Intra-abdominal Infections

• For non-critically ill, immunocompetent patients with adequate source control: Amoxicillin/clavulanate 2 g/0.2 g every 8 hours 2

Precautions and Monitoring

• Monitor for hypersensitivity reactions, including anaphylaxis and severe cutaneous adverse reactions 1
• Watch for Clostridioides difficile-associated diarrhea 1
• Common adverse reactions include diarrhea, rash, vomiting, and nausea 1
• Drug interactions:
  • Not recommended with probenecid
  • May increase prothrombin time with oral anticoagulants
  • Increased risk of rash with allopurinol
  • May reduce efficacy of oral contraceptives 1

Clinical Pearls

• Augmentin provides coverage against beta-lactamase-producing pathogens, making it effective against resistant strains of H. influenzae and M. catarrhalis 3
• For infections with suspected beta-lactamase-producing organisms, Augmentin is preferred over amoxicillin alone 3
• The combination has shown high clinical cure rates (>88%) in respiratory and other serious bacterial infections 4
• Intravenous formulation is available for severe infections requiring parenteral therapy 4, 5, 6
• The low propensity to select resistance mutations contributes to its long-term clinical effectiveness 3

Remember to complete the full course of antibiotics even if symptoms improve before completion to prevent the development of antibiotic resistance and ensure complete eradication of the infection 1.