What is the recommended daily dose of Augmentin (amoxicillin/clavulanate)?

Augmentin Daily Dose

For adults with standard infections, Augmentin 875 mg/125 mg twice daily or 500 mg/125 mg three times daily are the recommended regimens, with the 875 mg formulation preferred for respiratory tract infections and the 500 mg formulation adequate for mild-to-moderate infections. 1

Adult Dosing by Infection Severity

Standard Infections (Mild-to-Moderate)

• 500 mg/125 mg three times daily provides adequate coverage for mild-to-moderate infections of the ear/nose/throat, skin/skin structure, and genitourinary tract 1, 2
• This translates to a total daily dose of 1500 mg amoxicillin and 375 mg clavulanate 1

Severe Infections or Respiratory Tract Infections

• 875 mg/125 mg twice daily is specifically recommended for respiratory infections including acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 1, 2
• This provides a total daily dose of 1750 mg amoxicillin and 250 mg clavulanate 1
• For lower respiratory tract infections of any severity, use 875 mg every 12 hours or 500 mg every 8 hours 2

High-Dose Regimen for Resistant Pathogens

• 2000 mg/125 mg twice daily (Augmentin XR formulation) achieves adequate serum concentrations to eradicate penicillin-resistant Streptococcus pneumoniae with amoxicillin MICs up to 4-8 mg/L 3
• Consider this higher dose when antibiotic resistance is likely, including recent antibiotic use, prior antibiotic therapy failure, or high prevalence of resistant bacteria in the community 3

Pediatric Dosing (≥3 Months and <40 kg)

Mild-to-Moderate Infections

• 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours (based on amoxicillin component) 2

Severe Infections or Lower Respiratory Tract

• 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours (based on amoxicillin component) 2

High-Dose Pediatric Formulation

• 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses for acute bacterial rhinosinusitis and resistant infections (maximum 2000 mg amoxicillin per day) 3

Special Clinical Scenarios

Chronic Group A Streptococcal Carriers

• 40 mg/kg/day of amoxicillin component in three equally divided doses for 10 days in pediatric patients 4, 1
• In adults: 500 mg twice daily for 10 days for recurrent streptococcal pharyngitis 1
• Note: Augmentin is NOT first-line for acute strep pharyngitis; use penicillin V or amoxicillin alone 1

H. pylori Infection (Adults Only)

• Triple therapy: 1000 mg twice daily (every 12 hours) with clarithromycin 500 mg and lansoprazole 30 mg for 14 days 2
• Dual therapy: 1000 mg three times daily (every 8 hours) with lansoprazole 30 mg for 14 days 2

Intravenous Dosing

• 1.2 g IV every 8 hours for most infections including skin/soft tissue, intra-abdominal, and respiratory tract infections 5
• For complicated intra-abdominal infections in non-critically ill patients: 2 g/0.2 g every 8 hours 3

Duration of Therapy

• Respiratory infections: 5-7 days for uncomplicated acute bacterial rhinosinusitis in adults 1, 3
• Sinusitis: 10-14 days or until symptomatically improved for 7 days 3
• Streptococcal infections: 10 days minimum to prevent acute rheumatic fever 4, 2
• Urinary tract infections: 3-7 days for uncomplicated cases 3
• Skin/soft tissue infections: 7-10 days 5

Critical Dosing Considerations

Renal Impairment

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours depending on infection severity 2
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours 2
• Patients with GFR <30 mL/min should NOT receive the 875 mg dose 2
• Hemodialysis: 500 mg or 250 mg every 24 hours, with an additional dose during and at the end of dialysis 2

Common Pitfalls to Avoid

• Never substitute two 250 mg tablets for one 500 mg tablet, as this results in excessive clavulanate dosing 1
• Take at the start of a meal to minimize gastrointestinal intolerance 2
• Evaluate clinical response within 48-72 hours of initiating therapy 3
• Complete the full course even if symptoms improve, particularly for streptococcal infections to prevent acute rheumatic fever 1, 2