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

Augmentin (Amoxicillin-Clavulanate) Dosing Recommendations

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

Standard Adult Dosing by Infection Severity

Mild-to-Moderate Infections

• 500 mg/125 mg three times daily (every 8 hours) 1, 2
• This provides adequate coverage for uncomplicated respiratory infections, skin infections, and urinary tract infections 1
• Take at the start of meals to minimize gastrointestinal intolerance 2

Moderate-to-Severe Infections

• 875 mg/125 mg twice daily (every 12 hours) 1, 2
• Specifically recommended for respiratory infections including acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 1
• Also appropriate for skin/soft tissue infections and animal/human bites 1

Severe Infections Requiring IV Therapy

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

Treatment Duration by Indication

Respiratory Tract Infections

• 5-7 days for uncomplicated acute bacterial rhinosinusitis 1
• 5-7 days for pneumonia if afebrile for 48 hours and clinically stable 3, 1
• 7-10 days for most other respiratory infections 3
• Continue treatment for minimum 48-72 hours beyond resolution of symptoms 2

Streptococcal Infections

• 10 days minimum for any Streptococcus pyogenes infection to prevent acute rheumatic fever 2
• For chronic streptococcal carriers: 500 mg twice daily for 10 days (or 40 mg/kg/day in three divided doses for pediatrics) 1, 4

Specific Pathogens (from Taiwan Guidelines)

• Methicillin-susceptible Staphylococcus aureus: 1.2 g IV/PO every 8 hours 3
• Beta-lactamase positive Haemophilus influenzae: 1.2 g IV/PO every 12 hours 3
• Burkholderia pseudomallei eradication phase: 20/5 mg/kg PO every 8 hours, up to maximum 1500/375 mg every 8 hours 3

Critical Dosing Considerations

DO NOT Substitute Formulations

• Never substitute two 250 mg tablets for one 500 mg tablet - this results in excessive clavulanate dosing and increased gastrointestinal side effects 1
• The 875/125 mg formulation maintains optimal amoxicillin:clavulanate ratio 1

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 in patients with GFR <30 mL/min 2

Pediatric Dosing (≥3 Months and <40 kg)

Standard Dosing

• Mild 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 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 high-risk patients 4
• Risk factors include: age <2 years, daycare attendance, recent antibiotic use within 30 days, moderate-to-severe illness 4

Infants <3 Months

• Maximum 30 mg/kg/day divided every 12 hours due to incompletely developed renal function 2
• No dosing recommendations exist for infants with renal impairment 2

Special Clinical Scenarios

H. pylori Infection (Adults Only)

• Triple therapy: 1 gram amoxicillin + 500 mg clarithromycin + 30 mg lansoprazole, all twice daily for 14 days 2
• Dual therapy: 1 gram amoxicillin + 30 mg lansoprazole, both three times daily for 14 days 2

Aspiration Pneumonia/Anaerobic Coverage

• 1.2 g IV every 8 hours or 1-2 g PO every 12 hours 3
• Alternative: 400 mg moxifloxacin daily or 1 g ertapenem daily 3

Common Pitfalls to Avoid

• Incomplete courses: Always complete the full prescribed duration, even if symptoms resolve, to prevent treatment failure and resistance 1
• Wrong formulation for severity: Use 875 mg formulation for standard community-acquired infections requiring empiric therapy 1
• Ignoring renal function: Severe renal impairment requires dose adjustment; 875 mg dose is contraindicated in GFR <30 mL/min 2
• Inadequate dosing for resistant organisms: In areas with >10% resistant S. pneumoniae or in high-risk patients, use higher doses (80-90 mg/kg/day in pediatrics) 4

Guideline Consensus

The Infectious Diseases Society of America, American Academy of Otolaryngology-Head and Neck Surgery, and Taiwan guidelines all converge on similar dosing strategies, with the 875/125 mg twice daily formulation being the preferred choice for most adult respiratory infections 3, 1. The European Respiratory Society guidelines from 1998 support similar dosing but are superseded by more recent recommendations 3.