Starting Dose of Augmentin for Adults
For most adult patients, start with Augmentin 500 mg/125 mg every 12 hours for mild-to-moderate infections, or 875 mg/125 mg every 12 hours for respiratory tract infections and more severe infections. 1
Standard Dosing Algorithm
For Mild-to-Moderate Infections
- Start with 500 mg amoxicillin/125 mg clavulanate every 12 hours for uncomplicated skin/soft tissue infections, uncomplicated urinary tract infections, and mild respiratory infections 2, 3, 1
- Alternative regimen: 250 mg/125 mg every 8 hours, though the every-12-hour regimen is preferred due to significantly less diarrhea 1
For Respiratory Tract Infections and More Severe Infections
- Start with 875 mg/125 mg every 12 hours for acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 2, 3, 1
- This higher dose is specifically recommended by the Infectious Diseases Society of America for respiratory infections 2
- Alternative regimen: 500 mg/125 mg every 8 hours 1
For Drug-Resistant Pathogens
- Use 2000 mg/125 mg twice daily when treating patients at risk for drug-resistant Streptococcus pneumoniae, such as those with recent antibiotic use within 4-6 weeks, immunodeficiency, or frequent daycare exposure 4
- The Infectious Diseases Society of America specifically recommends this high-dose regimen for moderate disease or recent antibiotic exposure 4
Critical Dosing Considerations
Administration Timing
- Take at the start of a meal to enhance absorption of clavulanate and minimize gastrointestinal intolerance 1
- May be taken without regard to meals, but starting with food is preferred 1
Common Pitfalls to Avoid
- Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet because both contain the same amount of clavulanic acid (125 mg), resulting in excessive clavulanate dosing and increased gastrointestinal side effects 2, 4, 1
- The 250 mg/125 mg tablet and 250 mg/62.5 mg chewable tablet are not interchangeable due to different clavulanate content 1
Duration of Treatment
- For acute bacterial rhinosinusitis: 5-7 days 2, 3
- For streptococcal infections: 10 days 2
- For community-acquired pneumonia: duration based on clinical response 3
- For acute exacerbations of chronic bronchitis: at least 7 days 3
When to Reassess or Switch Therapy
- If no clinical improvement occurs after 72 hours, switch to a respiratory fluoroquinolone (levofloxacin or moxifloxacin) or consider alternative diagnoses 4
- The American Academy of Otolaryngology-Head and Neck Surgery recommends reevaluating for complications or non-bacterial etiology if initial therapy fails 4
Renal Dosing Adjustments
- For severe renal impairment (GFR <30 mL/min): reduce to 250-500 mg every 12 hours for GFR 10-30 mL/min, or 250-500 mg every 24 hours for GFR <10 mL/min 4