Augmentin Dosing for Streptococcal Infections
Augmentin is NOT a first-line agent for acute Group A streptococcal pharyngitis, but when used for chronic streptococcal carriers with recurrent symptomatic episodes, the recommended adult dose is 500 mg twice daily for 10 days. 1, 2
Primary Treatment Recommendations
For standard acute Group A streptococcal pharyngitis, Augmentin should not be your initial choice. The preferred agents are:
- Penicillin V or amoxicillin remain the first-line antibiotics due to narrow spectrum, minimal adverse effects, and low cost 1
- Penicillin V: 500 mg twice daily for 10 days in adults 1
- Amoxicillin: 1000 mg once daily for 10 days in adults 1
When Augmentin IS Indicated for Strep
Chronic Streptococcal Carriers with Recurrent Episodes
Adult dosing: 500 mg (amoxicillin component) twice daily for 10 days 1, 2
Pediatric dosing: 40 mg/kg/day of the amoxicillin component divided into three doses (maximum 2000 mg amoxicillin per day) for 10 days 1, 2
This specific indication applies when patients have multiple documented episodes of culture-positive pharyngitis despite adequate prior treatment, suggesting they are chronic carriers experiencing concurrent viral infections 1
Critical Dosing Considerations
Do not substitute two 250 mg tablets for one 500 mg tablet - this results in excessive clavulanate dosing and increased gastrointestinal side effects 2
Always complete the full 10-day course for any streptococcal infection to prevent acute rheumatic fever, regardless of clinical improvement 1, 3
Take at the start of meals to minimize gastrointestinal intolerance 3
Clinical Context and Pitfalls
The rationale for using Augmentin in chronic carriers is that the clavulanate component may help eradicate streptococci that are more difficult to eliminate from the pharynx 1. However, this represents a minority clinical scenario.
Common mistake: Prescribing Augmentin for routine acute strep throat. This unnecessarily exposes patients to broader spectrum coverage, higher cost, and increased risk of Clostridium difficile infection compared to penicillin or amoxicillin alone 1
The bacteriologic eradication rate with amoxicillin-clavulanate (83% at 21-28 days) is comparable to penicillin V (77%) in streptococcal pharyngitis 4, but this does not justify its routine use given the disadvantages.
For penicillin-allergic patients with acute strep pharyngitis, use cephalexin, clindamycin, azithromycin, or clarithromycin instead - not Augmentin 1