What are the dosing recommendations for Augmentin (amoxicillin/clavulanate) and Doxycycline in the treatment of pneumonia?

Augmentin and Doxycycline Dosing for Pneumonia

For community-acquired pneumonia, amoxicillin/clavulanate (Augmentin) should be dosed at 875 mg/125 mg twice daily or 500 mg/125 mg three times daily for outpatients with comorbidities, while doxycycline should be dosed at 100 mg twice daily. 1, 2

Augmentin (Amoxicillin/Clavulanate) Dosing

For Healthy Outpatients Without Comorbidities:

• Amoxicillin alone is recommended at 1 g three times daily 1, 3

For Outpatients With Comorbidities:

• Amoxicillin/clavulanate 500 mg/125 mg three times daily, OR
• Amoxicillin/clavulanate 875 mg/125 mg twice daily, OR
• Amoxicillin/clavulanate 2000 mg/125 mg twice daily 1, 2, 3

Administration Considerations:

• Take at the start of a meal to minimize gastrointestinal intolerance and enhance clavulanate absorption 4
• For more severe infections and respiratory tract infections, use the higher dose formulations 4
• Two 250 mg/125 mg tablets should not be substituted for one 500 mg/125 mg tablet as they contain the same amount of clavulanic acid 4

Special Formulations:

• Augmentin XR (2000/125 mg twice daily) is available for adults with respiratory infections caused by drug-resistant pathogens 5, 6
• This extended-release formulation maintains therapeutic concentrations of amoxicillin over longer periods through a bilayer tablet design 5, 6

Doxycycline Dosing

For Healthy Outpatients:

• Doxycycline 100 mg twice daily 1, 2

For Outpatients With Comorbidities:

• Can be used as an alternative to macrolides in combination therapy with amoxicillin/clavulanate at 100 mg twice daily 1

Combination Therapy Considerations

• For outpatients with comorbidities, amoxicillin/clavulanate should be combined with either:

  • A macrolide (azithromycin 500 mg on first day then 250 mg daily, or clarithromycin 500 mg twice daily or extended-release 1000 mg daily), OR
  • Doxycycline 100 mg twice daily 1, 2

• Monotherapy with a respiratory fluoroquinolone is an alternative for patients with comorbidities 2

Clinical Pearls and Pitfalls

• Avoid macrolide monotherapy in areas with pneumococcal resistance to macrolides ≥25% 1, 2
• If a patient has had recent exposure to one class of antibiotics, select treatment from a different class due to increased risk of bacterial resistance 2
• For patients not improving on initial therapy, consider adding or substituting a macrolide if on beta-lactam monotherapy 2
• Underestimating pneumonia severity can lead to inappropriate treatment intensity 2
• The twice-daily regimen of amoxicillin/clavulanate is associated with significantly less diarrhea than three-times-daily dosing 4