Augmentin Dosing for Parotitis
For bacterial parotitis in adults, use Augmentin 875 mg/125 mg twice daily for 7-10 days, or alternatively 500 mg/125 mg three times daily for mild-to-moderate infections. 1
Rationale for Dosing Selection
While specific guideline-based dosing for parotitis is not explicitly detailed in major infectious disease guidelines, the recommended approach extrapolates from head and neck infection treatment principles:
Standard adult dosing of 875 mg/125 mg twice daily provides adequate coverage for typical bacterial pathogens causing parotitis, including Staphylococcus aureus and oral anaerobes. 1
Alternative standard dosing of 500 mg/125 mg three times daily is appropriate for mild-to-moderate infections and provides equivalent coverage according to the Infectious Diseases Society of America. 1
High-Dose Regimen Considerations
High-dose Augmentin (2000 mg/125 mg twice daily) should be considered if there is concern for drug-resistant pathogens, particularly in patients with recent antibiotic use within 4-6 weeks, immunocompromised status, or healthcare-associated infection. 2, 3
This high-dose regimen achieves adequate serum concentrations to eradicate resistant Streptococcus pneumoniae with MICs up to 4-8 mg/L. 3
Duration of Therapy
Treatment duration of 7-10 days is recommended for most bacterial parotitis cases, consistent with respiratory and head/neck infection guidelines. 3
Clinical response should be evaluated within 48-72 hours of initiating therapy. 3
Pediatric Dosing
For children with parotitis, use high-dose amoxicillin/clavulanate at 90 mg/6.4 mg per kg per day divided into two doses for moderate-to-severe infections. 3
A case report documented successful treatment of neonatal parotitis with intravenous Augmentin, though specific dosing was not detailed. 4
Treatment Failure Management
If no improvement occurs after 72 hours, switch to a respiratory fluoroquinolone (levofloxacin or moxifloxacin) or consider alternative diagnoses including viral parotitis, salivary duct obstruction, or abscess formation requiring drainage. 5
Reevaluation for complications or non-bacterial etiology is essential if symptoms persist despite appropriate antibiotic therapy. 5
Critical Dosing Pitfalls to Avoid
Never substitute two 250 mg tablets for one 500 mg tablet, as this results in excessive clavulanate dosing (250 mg vs 125 mg) and significantly increases gastrointestinal side effects. 1
Complete the full course even if symptoms improve early to prevent treatment failure and resistance development. 5
Dose adjustment is required for severe renal impairment (GFR <30 mL/min): reduce to 250-500 mg every 12 hours for GFR 10-30 mL/min, or every 24 hours for GFR <10 mL/min. 5