Augmentin Dosing Recommendations
Standard Adult Dosing by Infection Type
For most adult respiratory tract infections, use Augmentin 875 mg/125 mg twice daily, which provides optimal coverage for common pathogens including penicillin-resistant Streptococcus pneumoniae. 1
Respiratory 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
- Duration: 5-7 days for uncomplicated acute bacterial rhinosinusitis 1
- For community-acquired pneumonia requiring hospitalization, consider 1.2 g IV every 8 hours for moderate severity cases 2
Skin and Soft Tissue Infections
- 875 mg/125 mg twice daily for standard skin and soft tissue infections 1
- 500 mg/125 mg twice daily for animal or human bites 1, 2
- Duration: 5-7 days after clinical improvement 2
Mild-to-Moderate Infections
- 500 mg/125 mg three times daily provides adequate coverage for mild-to-moderate ear/nose/throat, skin, and genitourinary infections 1, 3
- This is the FDA-approved standard dose for less severe infections 3
Special Clinical Scenarios
Streptococcal Infections
- For acute Group A strep pharyngitis: Use penicillin V or amoxicillin alone as first-line, NOT Augmentin 1
- For chronic streptococcal carriers with recurrent symptomatic episodes: 500 mg (amoxicillin component) twice daily for 10 days 1
- Critical: Complete the full 10-day course to prevent acute rheumatic fever, regardless of clinical improvement 1
Severe Infections Requiring IV Therapy
- 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 1
- For intra-abdominal infections: 4-7 days duration with adequate source control 1
- For critically ill patients or severe sepsis, consider increasing to every 6 hours (QID) for optimal bacterial killing 2
High-Dose Formulations for Resistant Pathogens
In geographic areas with high rates of penicillin-resistant S. pneumoniae, use the pharmacokinetically enhanced formulation of 2000 mg/125 mg twice daily (Augmentin XR). 4
- This formulation was specifically developed for drug-resistant respiratory pathogens 4
- Provides enhanced coverage against S. pneumoniae with reduced penicillin susceptibility and beta-lactamase-producing H. influenzae and M. catarrhalis 4
Critical Dosing Considerations and Pitfalls
Renal Impairment
- 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
- Never use the 875 mg dose in patients with GFR <30 mL/min 3
Common Pitfalls to Avoid
- Never substitute two 250 mg tablets for one 500 mg tablet, as this results in excessive clavulanate dosing and increased gastrointestinal side effects 1
- Always take at the start of a meal to minimize gastrointestinal intolerance 3
- For any Streptococcus pyogenes infection, ensure at least 10 days of treatment to prevent acute rheumatic fever 3
Drug Interactions
- Not recommended with probenecid 2
- May increase prothrombin time with oral anticoagulants—monitor INR closely 2