What is the recommended dosage and treatment duration for Augmentin (amoxicillin-clavulanate)?

Augmentin (Amoxicillin-Clavulanate) Dosing Recommendations

For adults with respiratory tract infections, use 875 mg/125 mg twice daily for 5-7 days, or 500 mg/125 mg three times daily for mild-to-moderate infections. 1, 2

Standard Adult Dosing by Infection Severity

Mild to Moderate Infections

• 500 mg/125 mg three times daily (every 8 hours) for ear/nose/throat, skin/skin structure, and genitourinary tract infections 2
• Alternative: 875 mg/125 mg twice daily (every 12 hours) for respiratory infections including acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 1
• Duration: 5-7 days for most respiratory infections 1, 3

Severe Infections

• 875 mg/125 mg twice daily or 500 mg/125 mg three times daily for severe ear/nose/throat, skin, and genitourinary infections 2
• Lower respiratory tract infections (any severity): 875 mg/125 mg twice daily or 500 mg/125 mg three times daily 2

Intravenous Dosing for Serious Infections

• 1.2 g IV every 8 hours for complicated intra-abdominal infections, severe respiratory infections, and severe skin/soft tissue infections 1, 3
• Duration: 4-7 days with adequate source control for intra-abdominal infections 1

Specific Clinical Indications

Community-Acquired Pneumonia

• Moderate severity (non-ICU): 1.2 g IV every 8 hours 3
• Outpatient with comorbidities: 1-2 g PO every 12 hours 3
• Duration: 5-7 days if afebrile for at least 48 hours with no more than one CAP-associated sign of clinical instability 3

Acute Bacterial Rhinosinusitis

• Mild disease without recent antibiotic use: 500 mg/125 mg three times daily 3
• Moderate disease or recent antibiotic use (past 4-6 weeks): 4 g/250 mg per day (high-dose formulation) 3
• Duration: 5-7 days for uncomplicated cases 1

Skin and Soft Tissue Infections

• Animal or human bites: 500 mg/125 mg twice daily 1
• Standard infections: 875 mg/125 mg twice daily 1

Methicillin-Susceptible Staphylococcus aureus Pneumonia

• 1.2 g IV/PO every 8 hours 3
• Duration: Up to 4 weeks may be considered if S. aureus bacteremia is present 3

Haemophilus influenzae (β-lactamase positive)

• 1.2 g IV/PO every 12 hours 3
• Duration: 7-10 days 3

Burkholderia pseudomallei (Eradication phase)

• 20/5 mg/kg PO every 8 hours, up to maximum of 1500/375 mg PO every 8 hours 3

Pediatric Dosing (≥3 months and <40 kg)

Standard Dosing

• Mild/moderate infections: 25 mg/kg/day (amoxicillin component) divided every 12 hours or 20 mg/kg/day divided every 8 hours 2
• Severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 2

High-Dose Regimen for Resistant Organisms

• 80-90 mg/kg/day (amoxicillin component) with 6.4 mg/kg/day (clavulanate) in 2 divided doses for severe infections or areas with high prevalence of resistant S. pneumoniae (>10%) 4
• Maximum: 2 g per dose 4

Risk Factors Requiring High-Dose Therapy

• Age younger than 2 years 4
• Attendance at childcare 4
• Recent antimicrobial treatment within previous 30 days 4
• Moderate to severe illness 4

Infants <3 Months

• Maximum 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2

Special Populations

Renal Impairment

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 2
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours 2
• Hemodialysis: 500 mg or 250 mg every 24 hours, with additional dose during and at end of dialysis 2
• Do NOT use 875 mg dose if GFR <30 mL/min 2

H. pylori Infection (Adults Only)

• Triple therapy: 1 g twice daily (every 12 hours) with clarithromycin 500 mg and lansoprazole 30 mg for 14 days 2
• Dual therapy: 1 g three times daily (every 8 hours) with lansoprazole 30 mg for 14 days 2

Critical Dosing Considerations

Formulation Warning

• Never substitute two 250 mg tablets for one 500 mg tablet as this results in excessive clavulanate dosing 1

Duration Principles

• Minimum 10 days for Streptococcus pyogenes infections to prevent acute rheumatic fever 2, 1
• Continue for 48-72 hours beyond clinical improvement or evidence of bacterial eradication 2
• Longer courses (up to 4 weeks) may be needed for S. aureus bacteremia 3

Administration

• Take at the start of a meal to minimize gastrointestinal intolerance 2
• Shake oral suspension well before using 2
• Discard reconstituted suspension after 14 days 2

Common Pitfalls to Avoid

• Using standard doses for drug-resistant S. pneumoniae—requires high-dose formulations (4 g/250 mg daily for adults or 80-90 mg/kg/day for children) 3, 4
• Stopping therapy early for streptococcal infections—always complete 10 days to prevent rheumatic fever 1, 2
• Using 875 mg dose in severe renal impairment (GFR <30 mL/min)—contraindicated 2
• Inadequate dosing for pneumonia in ICU patients—requires combination therapy with macrolide or fluoroquinolone 3