Augmentin (Amoxicillin/Clavulanate) Dosing Recommendations
Standard Adult Dosing
For most mild-to-moderate infections in adults, use 500 mg/125 mg three times daily or 875 mg/125 mg twice daily, with the 875 mg formulation preferred for respiratory tract infections. 1, 2, 3
Infection-Specific Adult Dosing:
Respiratory Tract Infections:
- 875 mg/125 mg twice daily is the preferred dose for acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 1, 2, 4
- Duration: 5-7 days for uncomplicated acute bacterial rhinosinusitis 1
- For high-risk respiratory infections, use 2 g/125 mg twice daily 4
Ear/Nose/Throat, Skin/Soft Tissue, and Genitourinary Infections:
- Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours 3
- Severe: 875 mg every 12 hours or 500 mg every 8 hours 3
H. pylori Infection:
- Triple therapy: 1 gram amoxicillin + 500 mg clarithromycin + 30 mg lansoprazole, all twice daily for 14 days 3
- Dual therapy: 1 gram amoxicillin + 30 mg lansoprazole, both three times daily for 14 days 3
Emergency Standby for Asplenic Patients:
- 3 g starting dose followed by 1 g every 8 hours for unexplained fever or constitutional symptoms 5
- For animal bites in asplenic patients: amoxicillin/clavulanate for 5 days 5
Pediatric Dosing (≥3 Months and <40 kg)
For children with respiratory tract infections or severe infections, use 45 mg/kg/day of the amoxicillin component divided every 12 hours or 40 mg/kg/day divided every 8 hours. 3
Standard Pediatric Regimens:
Mild/Moderate Infections (Ear/Nose/Throat, Skin, Genitourinary):
- 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 3
Severe Infections or Lower Respiratory Tract:
- 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 3
High-Dose Regimen (for drug-resistant pathogens):
- 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in 2 divided doses 4
- Indications: age <2 years, daycare attendance, recent antibiotic use, moderate-to-severe illness, or areas with high penicillin-resistant S. pneumoniae 4
- Maximum single dose: 2 grams regardless of weight 4
Age-Based Oral Suspension Dosing:
- <1 year: 2.5 mL of 125/31 suspension three times daily 4
- 1-6 years: 5 mL of 125/31 suspension three times daily 4
- 7-12 years: 5 mL of 250/62 suspension three times daily 4
- 12-18 years: 1 tablet (250/125) three times daily 4
Infants <3 Months:
- Maximum dose: 30 mg/kg/day divided every 12 hours due to immature renal function 3
Emergency Standby for Asplenic Children:
- 50 mg/kg in three divided daily doses 5
Renal Impairment Dosing
Patients with GFR <30 mL/min should NOT receive the 875 mg dose. 3
Dose Adjustments:
- GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 3
- GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3
- Hemodialysis: 500 mg or 250 mg every 24 hours, with an additional dose during and at the end of dialysis 3
Critical Administration and Duration Considerations
Take at the start of a meal to minimize gastrointestinal intolerance. 3
Continue treatment for a minimum of 48-72 hours beyond symptom resolution or evidence of bacterial eradication. 3
For Streptococcus pyogenes infections, treat for at least 10 days to prevent acute rheumatic fever. 1, 3
Important Dosing Pitfalls
Never substitute two 250 mg tablets for one 500 mg tablet—this results in excessive clavulanate dosing and increased gastrointestinal side effects. 1
The clavulanate component is fixed at 125 mg per dose in standard adult formulations, regardless of amoxicillin content. 2
If no improvement occurs after 72 hours, switch to a respiratory fluoroquinolone or high-dose amoxicillin/clavulanate if not already used. 2