What is Augmentin Used For?
Augmentin (amoxicillin-clavulanate) is a broad-spectrum antibiotic used to treat bacterial infections of the respiratory tract, urinary tract, skin and soft tissues, and certain other bacterial infections where beta-lactamase-producing organisms or resistant pathogens are suspected. 1
Primary Indications
Respiratory Tract Infections
Augmentin is a first-line or preferred agent for several respiratory infections:
Acute otitis media (AOM) in children, particularly when severe symptoms are present, recent antibiotic exposure (within 6 weeks), or high local prevalence of amoxicillin-resistant Haemophilus influenzae exists 2
Acute bacterial sinusitis when similar risk factors are present (severe symptoms, recent antibiotic exposure, known high local prevalence of resistant organisms) 2
Community-acquired pneumonia (CAP) in both adults and children, where it demonstrates 97.0% clinical response rates 3, 4. High-dose formulations (2000/125 mg twice daily for adults) are specifically designed for drug-resistant Streptococcus pneumoniae 2, 4
Acute exacerbations of chronic bronchitis in adults 4
The addition of clavulanate to amoxicillin preserves activity against beta-lactamase-producing H. influenzae and Moraxella catarrhalis, which are common respiratory pathogens 2, 4. However, recognize that adverse events (diarrhea, rash, vomiting, abdominal pain) occur in 44% of patients treated with high-dose amoxicillin-clavulanate compared to 14% with placebo 2.
Urinary Tract Infections
Augmentin is recommended as a first-choice option for lower urinary tract infections 2:
Cystitis in adults and children, with clinical success rates of 97.8% 3, 5
Particularly valuable for multiply resistant bacteria, achieving approximately 70% success rates even against amoxicillin-resistant organisms 5
The WHO Essential Medicines guidelines specifically list amoxicillin-clavulanate as a first-choice Access group antibiotic for lower UTIs 2.
Skin and Soft Tissue Infections
Augmentin demonstrates 95.7% clinical response rates in skin and soft tissue infections 3:
Primary skin sepsis, infected eczema, infected trauma, and leg ulcers 6
Particularly effective against mixed infections with penicillin-resistant Staphylococcus aureus and Streptococcus pyogenes 6
94% of patients with skin infections respond to treatment 6
Other Indications
Pelvic inflammatory disease (100% response rate in clinical studies) 3
Bacteremia/septicemia (91.4% response rate, though this represents more severe disease) 3
Osteomyelitis and other bone/joint infections 7
Key Prescribing Considerations
When to Choose Augmentin Over Plain Amoxicillin
Select amoxicillin-clavulanate specifically when:
- Severe symptoms are present at initial presentation 2
- Recent antibiotic exposure within the past 6 weeks 2
- Known high local prevalence of beta-lactamase-producing organisms 2
- Treatment failure with amoxicillin alone 2
Plain amoxicillin remains appropriate for most uncomplicated cases without these risk factors, as it has lower rates of adverse events (particularly diarrhea) 2.
Dosing Formulations
High-dose formulations are critical for resistant pathogens:
- Adults: 2000/125 mg twice daily (pharmacokinetically enhanced formulation) for resistant S. pneumoniae 2, 4
- Children: 90 mg/kg/day amoxicillin with 6.4 mg/kg/day clavulanate in two divided doses (14:1 ratio) 2, 4
Standard dosing (875/125 mg twice daily for adults) remains appropriate for less severe infections or when resistance is not a concern 1.
Important Safety Considerations
Gastrointestinal adverse events are the primary limitation:
- Diarrhea occurs in 3.6-9% of patients 2, 3, 6
- Overall adverse events (including rash, vomiting, abdominal pain) occur in up to 44% with high-dose formulations 2
- Risk of Clostridium difficile colitis, though community-onset infections remain relatively uncommon 2
Monitor for serious but rare reactions:
Drug Interactions
- Oral anticoagulants: Monitor INR closely and adjust warfarin dosing as needed 1
- Allopurinol: Increases incidence of rashes 1
- Oral contraceptives: May reduce efficacy of combined estrogen/progesterone contraceptives 1
Special Populations
Renal impairment: Dosage adjustment required when GFR <30 mL/min, as amoxicillin is primarily renally eliminated 1
Pregnancy: Use only if clearly needed; no evidence of fetal harm in animal studies but limited human data 1
Nursing mothers: Excreted in breast milk; may cause infant sensitization 1