Renal Dosing Recommendations for Augmentin
For patients with moderate to severe renal impairment (CrCl 10-30 mL/min), reduce the Augmentin dose by approximately 50% or double the dosing interval; for end-stage renal disease (CrCl <10 mL/min), reduce to 25-50% of the normal dose, and for hemodialysis patients, administer the dose after dialysis. 1
Dosing Algorithm by Renal Function
Normal to Mild Renal Impairment (CrCl >30 mL/min)
- Use standard dosing regimens without adjustment 1
- No modification needed for patients with creatinine clearance above 30 mL/min 1
Moderate to Severe Renal Impairment (CrCl 10-30 mL/min)
- Reduce dose by 50% OR double the dosing interval 1
- Example: If standard dose is 875 mg twice daily, either give 437.5 mg (or 500 mg) twice daily OR 875 mg once daily 1
- This adjustment prevents drug accumulation while maintaining therapeutic efficacy 2
End-Stage Renal Disease (CrCl <10 mL/min)
- Reduce to 25-50% of normal dose 1
- More aggressive reduction needed due to severely impaired clearance 1
Hemodialysis Patients
- Administer dose after dialysis session 1
- This timing prevents premature drug removal during dialysis 3, 1
- Allows for direct observation and ensures adequate drug exposure 3
Clinical Considerations
Why Dose Adjustment is Critical
- Both amoxicillin and clavulanate are renally eliminated, making dose adjustment essential in renal impairment 2
- Failure to adjust dosing can lead to drug accumulation, increased adverse effects, and poor outcomes 2
- Drug dosing errors are common in patients with renal impairment and represent a significant safety concern 2
Monitoring Parameters
- Calculate creatinine clearance using online or electronic calculators rather than relying on serum creatinine alone 2
- Serum creatinine may underestimate renal impairment, particularly in elderly patients 2
- Monitor for signs of drug accumulation including gastrointestinal side effects and potential hepatotoxicity 2
Common Pitfalls to Avoid
- Do not assume all antibiotics require identical dose adjustments - each antibiotic has unique pharmacokinetic properties requiring individualized adjustments 1
- Do not rely solely on serum creatinine - it can be misleadingly normal despite significant renal impairment, especially in elderly or low muscle mass patients 2
- Do not forget post-dialysis dosing - administering before dialysis wastes medication and leaves patients undertreated 3, 1