Augmentin Dose Adjustment Based on GFR
For patients with GFR ≥30 mL/min, use standard Augmentin dosing without adjustment; for GFR 10-30 mL/min, reduce frequency to every 12 hours (500/125 mg or 250/125 mg depending on infection severity); for GFR <10 mL/min or hemodialysis patients, reduce to every 24 hours with an additional dose during and after dialysis. 1
Specific Dosing Recommendations by GFR Category
Normal to Mild Renal Impairment (GFR ≥30 mL/min)
- No dose adjustment required 1
- Standard adult dosing applies: 875/125 mg twice daily or 500/125 mg three times daily depending on infection severity 1
- The 875/125 mg formulation should not be used if GFR falls below 30 mL/min 1
Moderate Renal Impairment (GFR 10-30 mL/min)
- Reduce dosing frequency to every 12 hours 1
- Choose between:
- Both amoxicillin and clavulanic acid are renally excreted, necessitating this adjustment to prevent drug accumulation 2
Severe Renal Impairment (GFR <10 mL/min)
- Reduce dosing frequency to every 24 hours 1
- Choose between:
Hemodialysis Patients
- Administer 500/125 mg or 250/125 mg every 24 hours based on infection severity 1
- Critical timing consideration: Give an additional dose both during and at the end of dialysis, as hemodialysis removes both amoxicillin and clavulanic acid from circulation 1
- This supplemental dosing compensates for drug removal during the dialysis session 2
Important Clinical Considerations
Formulation Restrictions
- The 875/125 mg tablet is contraindicated when GFR <30 mL/min 1
- Different Augmentin formulations contain varying amounts of clavulanic acid and are not interchangeable: two 250/125 mg tablets do not equal one 500/125 mg tablet 1
Monitoring Requirements
- GFR estimation should guide initial dosing decisions 2, 3
- In elderly patients (>65 years), renal function may be overestimated by serum creatinine alone, increasing risk of drug accumulation 3, 4
- Patients with advanced chronic kidney disease require careful monitoring as GFR-estimating equations become less accurate at lower GFR values 4
Risk of Inappropriate Dosing
- Failure to adjust doses in renal impairment leads to excessive drug accumulation and increased toxicity risk 2
- In geriatric patients with reduced renal function, approximately 52% of medications require dosage adjustment, with antibiotics being among the most frequently used drugs needing modification 3
- Routine assessment and reporting of estimated GFR is essential for appropriate antibiotic dosing in patients with chronic kidney disease 3, 5