What is the recommended dosage of Augmentin (amoxicillin-clavulanate) for upper respiratory infections?

Augmentin Dosage for Upper Respiratory Infections

For adults with bacterial upper respiratory infections requiring antibiotics, prescribe Augmentin 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for 7-10 days. 1

Adult Dosing Recommendations

• Standard adult dose: Augmentin 875 mg/125 mg twice daily OR 500 mg/125 mg three times daily for 7-10 days 1
• This dosing applies specifically to patients who have not received antibiotics in the previous 4-6 weeks 1
• The 7-10 day duration is the standard recommendation across multiple guidelines for most upper respiratory infections 2, 1

Pediatric Dosing Recommendations

• For children with bacterial sinusitis: 80 mg/kg/day (amoxicillin component) divided into three doses, not exceeding 3 g/day 2
• For children under 3 years with pneumonia or lower respiratory infections: 80-100 mg/kg/day of the amoxicillin component in three divided doses 1
• For children 3-5 years: the 80 mg/kg/day dosing is justified when there is insufficient H. influenzae type b vaccination or coexisting purulent acute otitis media 1

When Antibiotics Are Actually Indicated

Critical caveat: Most upper respiratory infections are viral and do not require antibiotics. 3 Antibiotics should only be prescribed when bacterial infection is strongly suspected based on:

• Symptoms persisting beyond 10 days without improvement 3
• Severe symptoms: fever >39°C with purulent nasal discharge or facial pain for ≥3 consecutive days 3
• "Double sickening" pattern: worsening after initial improvement following a typical viral URI 3
• Acute bacterial sinusitis with unilateral/bilateral infraorbital pain worsening when bending forward, pulsatile pain peaking in early evening/night, or failure of initial symptomatic treatment 3

Alternative First-Line Options

If Augmentin is not suitable, consider:

• Second-generation cephalosporins: cefuroxime-axetil 3
• Third-generation cephalosporins: cefpodoxime-proxetil (8 mg/kg/day in two doses for children) 2, 3
• Note: First-generation cephalosporins like cephalexin are explicitly NOT recommended due to inadequate activity against penicillin-resistant S. pneumoniae 3

Monitoring and Reassessment

• Assess therapeutic efficacy after 2-3 days of treatment 3, 1
• Fever should resolve within 24 hours for pneumococcal infections and 2-4 days for other bacterial etiologies 3
• If no improvement occurs after 2-3 days, clinical and radiological reassessment is necessary, and hospitalization should be considered for complications 3
• Cough may persist longer and should not be used as the sole indicator of treatment failure 3

Common Pitfalls to Avoid

• Do not prescribe antibiotics for viral URIs - they cause more harm than benefit in most cases 3
• Do not use first-generation cephalosporins (like cephalexin) for respiratory infections due to inadequate coverage 3
• Do not assume all cephalosporins are equivalent - second and third-generation agents have significantly better activity against respiratory pathogens 3
• Do not use macrolides, first-generation cephalosporins, or cotrimoxazole due to high resistance prevalence 2

Adjunctive Therapies

Combine antibiotics with supportive measures to enhance outcomes:

• Intranasal saline irrigation to improve symptom relief 3
• Intranasal corticosteroids may enhance outcomes 3
• Analgesics and antipyretics for facial pain and fever management 3