What is the recommended dose of Augmentin (amoxicillin-clavulanate) for a Klebsiella urinary tract infection (UTI)?

Augmentin Dosing for Klebsiella UTI

For uncomplicated Klebsiella UTI, use Augmentin (amoxicillin-clavulanate) 875 mg/125 mg orally every 12 hours for 7 days; for complicated UTI or immunocompromised patients, use 2 g/0.2 g IV every 8 hours for 7-14 days. 1, 2

Standard Dosing by Clinical Scenario

Uncomplicated UTI in Immunocompetent Patients

• Augmentin 875 mg/125 mg orally every 12 hours for 7 days is the recommended regimen 2
• This dosing was validated in pivotal FDA trials showing comparable efficacy to the every-8-hour regimen with significantly lower rates of severe diarrhea (1% vs 2%) 2
• The 12-hour dosing interval provides better tolerability while maintaining therapeutic efficacy for complicated urinary tract infections 2

Complicated UTI or Critically Ill Patients

• Amoxicillin-clavulanate 2 g/0.2 g IV every 8 hours for adequate source control 1
• Duration should be 7-14 days based on clinical response and inflammation markers 1
• This higher dose is necessary for critically ill or immunocompromised patients with UTI 1

Male Patients (Always Complicated)

• All male UTIs are considered complicated regardless of other factors 3
• Use 875 mg/125 mg every 12 hours for 7-14 days minimum 3, 2
• The longer duration is necessary because male UTIs are more difficult to eradicate 3

High-Dose Regimen for ESBL-Producing Klebsiella

For ESBL-producing Klebsiella pneumoniae causing recurrent UTI, consider high-dose amoxicillin-clavulanate 2875 mg/125 mg orally twice daily as an alternative to carbapenems. 4

• A 2023 observational study demonstrated that this ultra-high-dose regimen successfully treated recurrent UTIs caused by ESBL-producing K. pneumoniae in 9 patients (including 7 kidney transplant recipients) with no therapeutic failures 4
• The protocol involves starting at 2875 mg/125 mg twice daily, then down-titrating every 7-14 days, followed by prophylactic dosing at 250 mg/125 mg for up to 3 months 4
• This approach may break antimicrobial resistance and serve as a carbapenem-sparing strategy in select cases 4

Important Clinical Considerations

When Augmentin May Not Be Appropriate

• If ESBL-producing Klebsiella is documented, first-line therapy should be carbapenem-based agents (ceftazidime-avibactam 2.5 g IV q8h, meropenem-vaborbactam 4 g IV q8h, or imipenem-cilastatin-relebactam 1.25 g IV q6h) 1
• For carbapenem-resistant Enterobacterales (CRE), Augmentin is not recommended; use newer beta-lactam/beta-lactamase inhibitor combinations instead 1
• Standard-dose Augmentin has limited efficacy against ESBL producers unless using the ultra-high-dose regimen described above 4

Combination Therapy Option

• Single-dose amikacin 15 mg/kg IV plus 7 days of oral amoxicillin-clavulanate showed 83% sterile culture rates for ESBL-producing E. coli and K. pneumoniae causing acute cystitis 5
• This combination may be considered as a carbapenem-sparing alternative for uncomplicated cystitis caused by ESBL producers 5

Monitoring and Follow-Up

• Obtain urine culture before starting therapy to confirm Klebsiella and susceptibility 3
• If symptoms don't improve within 48-72 hours, consider switching to parenteral therapy or broader-spectrum antibiotics based on culture results 3
• Follow-up cultures after completion of therapy are recommended to confirm eradication, especially in complicated cases 3

Common Pitfalls to Avoid

• Do not use standard-dose Augmentin empirically if ESBL-producing Klebsiella is suspected based on local epidemiology or patient risk factors (recent hospitalization, prior antibiotic use, healthcare-associated infection) 1
• Do not extend therapy beyond 14 days without investigating for underlying anatomical abnormalities or treatment failure 1, 3
• Do not assume all Klebsiella UTIs will respond to Augmentin—susceptibility testing is essential, as resistance patterns vary significantly 4, 6
• The historical cure rate for amoxicillin-resistant organisms with Augmentin is only about 70%, highlighting the importance of culture-directed therapy 6