Augmentin Dosing for CrCl 34 mL/min
For a patient with an estimated creatinine clearance of 34 mL/min, give Augmentin 500 mg/125 mg every 12 hours for moderate infections or 250 mg/125 mg every 12 hours for less severe infections. 1
Renal Dosing Adjustments
The FDA-approved prescribing information provides clear guidance for patients with moderate renal impairment:
- For CrCl 10-30 mL/min: Augmentin 500 mg/125 mg or 250 mg/125 mg every 12 hours (depending on infection severity) 1
- Your patient (CrCl 34 mL/min) falls just above this threshold but still requires careful consideration
Since your patient has a CrCl of 34 mL/min, they technically have a glomerular filtration rate >30 mL/min, which means standard dosing could theoretically be used. However, given the proximity to the 30 mL/min cutoff and the risk of drug accumulation, the conservative approach is to use the reduced dosing regimen of 500 mg/125 mg every 12 hours for moderate-to-severe infections or 250 mg/125 mg every 12 hours for less severe infections. 1
Critical Dosing Considerations
- Avoid the 875 mg/125 mg dose entirely - this formulation should not be used in patients with GFR <30 mL/min, and your patient is borderline 1
- Do not substitute tablet strengths - two 250 mg/125 mg tablets are NOT equivalent to one 500 mg/125 mg tablet due to different clavulanate content 1
- The severity of infection dictates whether to use 500 mg/125 mg versus 250 mg/125 mg at the 12-hour interval 1
Clinical Context
Dosing errors in patients with renal impairment are common and can lead to adverse effects and poor outcomes 2. The risk of medication accumulation and toxicity increases as renal function declines 2, 3. Studies show that adherence to renal dosing guidelines at hospital discharge occurs in only about 54% of cases, with 71% of non-adherent cases having potential to cause moderate-to-severe harm 3.