Augmentin Dosing for Infections
Standard Adult Oral Dosing
For most mild-to-moderate infections, the recommended dose is 500 mg/125 mg three times daily or 875 mg/125 mg twice daily, with the higher dose preferred for respiratory tract infections. 1
Mild-to-Moderate Infections
- 500 mg/125 mg every 12 hours is the standard regimen for uncomplicated infections 1
- Alternatively, 250 mg/125 mg every 8 hours can be used for less severe cases 1
- The 500/125 mg formulation provides adequate coverage according to IDSA guidelines 2
Respiratory Tract Infections (More Severe)
- 875 mg/125 mg every 12 hours is specifically recommended for respiratory infections including acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 2, 1
- Alternatively, 500 mg/125 mg every 8 hours for more severe respiratory infections 1
- Duration for uncomplicated acute bacterial rhinosinusitis is 5-7 days 2
Skin and Soft Tissue Infections
- 500 mg/125 mg twice daily for animal or human bites 3
- 875 mg/125 mg twice daily is appropriate for standard skin and soft tissue infections 3, 2
- Duration is typically 7-10 days depending on clinical response 4
Intravenous Dosing
For serious infections requiring IV therapy, the standard adult dose is 1.2 g (1000 mg amoxicillin/200 mg clavulanate) every 8 hours. 4, 5
Adult IV Regimens
- 1.2 g IV every 8 hours for most serious infections including complicated intra-abdominal infections, severe respiratory infections, and severe skin/soft tissue infections 3, 4, 5
- After initial IV therapy (typically 3 days), transition to oral therapy at the same dosage schedule if clinically appropriate 5
Duration by Infection Type
- Skin and soft tissue infections: 7-10 days 4
- Intra-abdominal infections: 4-7 days with adequate source control 3, 4
- Respiratory tract infections: 7-10 days depending on clinical response 4
Pediatric Dosing
Neonates and Infants <12 Weeks
- 30 mg/kg/day (amoxicillin component) divided every 12 hours 1
- Use the 125 mg/5 mL oral suspension formulation 1
Children ≥12 Weeks (3 Months) and Older
The every 12-hour regimen is preferred as it causes significantly less diarrhea. 1
Standard Dosing by Severity
- More severe infections (otitis media, sinusitis, lower respiratory tract): 45 mg/kg/day every 12 hours using 200 mg/5 mL or 400 mg/5 mL suspension 1
- Less severe infections: 25 mg/kg/day every 12 hours 1
- For acute otitis media, duration is 10 days 1
Alternative Every 8-Hour Regimen
- More severe infections: 40 mg/kg/day every 8 hours 1
- Less severe infections: 20 mg/kg/day every 8 hours 1
Children ≥40 kg
- Dose according to adult recommendations 1
- Do not use 250 mg/125 mg tablets until child weighs at least 40 kg due to different amoxicillin:clavulanate ratios 1
Pediatric IV Dosing
- 200 mg/kg/day (ampicillin-sulbactam equivalent) every 6 hours for complicated intra-abdominal infections 4
- Maximum daily dose should not exceed adult dosing 4
Special Clinical Scenarios
Streptococcal Infections
Augmentin is NOT first-line for acute streptococcal pharyngitis—use penicillin V or amoxicillin alone. 2
- For chronic streptococcal carriers with recurrent symptomatic episodes: 500 mg twice daily for 10 days in adults 2
- Pediatric carriers: 40 mg/kg/day divided into three doses for 10 days (maximum 2000 mg/day) 2
- Always complete the full 10-day course to prevent acute rheumatic fever 2
Lyme Disease with Cellulitis
- 500 mg three times daily for 14 days when covering both Lyme disease and bacterial cellulitis 2
Renal Impairment
- GFR <30 mL/min: Do not use 875 mg/125 mg dose 1
- GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours 1
- GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours 1
- Hemodialysis: 500 mg/125 mg or 250 mg/125 mg every 24 hours, with additional dose during and at end of dialysis 1
Critical Dosing Warnings
Formulation Substitution Errors
Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet—this results in excessive clavulanate dosing (250 mg vs. 125 mg) and increases gastrointestinal side effects. 2, 1
- The 250 mg/125 mg and 500 mg/125 mg tablets contain the same amount of clavulanic acid (125 mg), making them non-interchangeable 1
- The 250 mg/125 mg tablet and 250 mg/62.5 mg chewable tablet are also not interchangeable 1
- Do not confuse IV dosing (1.2 g every 8 hours) with oral dosing (875/125 mg twice daily)—these are different formulations with different pharmacokinetics 4