What is the recommended dose of Augmentin (amoxicillin-clavulanate) for acute diverticulitis?

Augmentin Dosing for Acute Diverticulitis

For acute diverticulitis requiring antibiotic therapy, Augmentin (amoxicillin-clavulanate) should be dosed at 875 mg/125 mg orally twice daily for 4-7 days in immunocompetent patients, or 10-14 days in immunocompromised patients. 1, 2

Critical Decision Point: Does This Patient Need Antibiotics?

Most immunocompetent patients with uncomplicated diverticulitis do NOT require antibiotics. 3 Multiple high-quality randomized controlled trials, including the DIABOLO trial with 528 patients, demonstrated that antibiotics neither accelerate recovery nor prevent complications or recurrence in uncomplicated cases. 3

Reserve Antibiotics For:

• Immunocompromised status (corticosteroids, chemotherapy, transplant recipients) 1, 2
• Systemic inflammatory response or sepsis 1, 2
• Age >80 years 1
• Significant comorbidities or frailty 1, 2
• Refractory symptoms or vomiting 1, 2
• Elevated inflammatory markers: CRP >140 mg/L or WBC >15 × 10^9/L 1, 2
• CT findings: fluid collection, longer segment of inflammation, or pericolic gas 1, 2
• Symptoms >5 days duration 1

Specific Augmentin Dosing Regimens

Outpatient Oral Therapy (First-Line When Antibiotics Indicated)

Standard dosing: Augmentin 875 mg/125 mg orally twice daily 4

• This provides appropriate polymicrobial coverage for gram-positive, gram-negative, and anaerobic bacteria commonly involved in colonic infections 1
• Should be taken at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance 4
• Alternative regimen: Ciprofloxacin 500 mg twice daily plus metronidazole 500 mg three times daily 1, 2

Inpatient IV-to-Oral Transition

Initial IV therapy: Amoxicillin-clavulanate 1200 mg IV four times daily for at least 48 hours 3

Transition to oral: Augmentin 625 mg orally three times daily after 48 hours once patient tolerates oral intake 3

• Transition to oral antibiotics should occur as soon as possible to facilitate earlier discharge 3, 1
• Hospital stay is actually shorter (2 vs 3 days) in observation groups compared to antibiotic-treated patients 3, 2

Duration of Therapy

Immunocompetent Patients

4-7 days total duration 1, 2

• This shorter course is supported by the STOP IT trial demonstrating adequate outcomes with 4 days post-operative therapy in complicated cases with source control 1

Immunocompromised Patients

10-14 days total duration 1, 2

• These patients are at significantly higher risk for progression to complicated diverticulitis and sepsis 1
• Includes patients on corticosteroids, chemotherapy, or immunosuppression for organ transplantation 1

Important Clinical Caveats

Dosing Considerations

• Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as both contain the same amount of clavulanic acid (125 mg) 4
• For patients weighing ≥40 kg, use adult dosing recommendations 4

Monitoring and Follow-Up

• Re-evaluate within 7 days; earlier if clinical condition deteriorates 3, 1
• Watch for warning signs requiring immediate attention: fever >101°F, severe uncontrolled pain, persistent vomiting, inability to eat/drink 1
• Avoid alcohol until at least 48 hours after completing metronidazole (if using combination therapy) to prevent disulfiram-like reactions 1

Common Pitfalls to Avoid

• Overuse of antibiotics in uncomplicated cases without risk factors—this contributes to antibiotic resistance without clinical benefit 3, 1, 5
• Stopping antibiotics early even if symptoms improve—this may lead to incomplete treatment and recurrence 1
• Automatically prescribing 10-14 days for all cases—longer duration is specifically for immunocompromised patients only 1
• Failing to recognize high-risk patients who need closer monitoring despite having uncomplicated disease 2

Outpatient Management Criteria

Augmentin outpatient therapy is appropriate when patients meet ALL of the following: 1, 2

• Able to tolerate oral fluids and medications
• No significant comorbidities or frailty
• Adequate home support
• Temperature <100.4°F
• Pain score <4/10 on visual analogue scale (controlled with acetaminophen only)
• Ability to maintain self-care at pre-illness level

If these criteria are not met, consider inpatient management with IV antibiotics. 1, 2