Augmentin Dose Adjustment for GFR 57
No dose adjustment is required for Augmentin (amoxicillin-clavulanate) at a GFR of 57 mL/min/1.73 m²—use standard adult dosing.
Dosing Algorithm Based on Renal Function
The FDA-approved prescribing information provides clear thresholds for dose adjustment based on glomerular filtration rate 1:
GFR ≥30 mL/min/1.73 m²: No dose adjustment needed; use standard adult dosing (typically 875 mg/125 mg twice daily or 500 mg/125 mg three times daily depending on infection severity) 1
GFR 10-30 mL/min/1.73 m²: Reduce frequency to every 12 hours (500 mg/125 mg or 250 mg/125 mg depending on severity); avoid the 875 mg/125 mg formulation 1
GFR <10 mL/min/1.73 m²: Reduce frequency to every 24 hours (500 mg/125 mg or 250 mg/125 mg depending on severity) 1
Hemodialysis patients: Administer 500 mg/125 mg or 250 mg/125 mg every 24 hours, with an additional dose both during and at the end of dialysis 1
Clinical Context for GFR 57
With a GFR of 57 mL/min/1.73 m², this patient has Stage 3a chronic kidney disease (mild-to-moderate renal impairment) but remains well above the threshold requiring dose modification 1. The kidneys retain sufficient function to clear amoxicillin and clavulanic acid adequately at standard doses 2.
Important Caveats
Monitor renal function during treatment: While no initial dose adjustment is needed, patients with borderline renal function (GFR 30-60 mL/min/1.73 m²) should have renal function monitored if prolonged therapy is required, as acute deterioration could necessitate dose reduction 2, 3.
Avoid the 875 mg formulation if GFR drops below 30: The higher-strength tablet should not be used once GFR falls below 30 mL/min/1.73 m², as this increases risk of drug accumulation and adverse effects 1.
Consider infection severity: For severe infections in patients with GFR 30-60 mL/min/1.73 m², standard dosing remains appropriate, but clinical response and tolerability should guide continuation 1, 4.