Duration of Augmentin (Amoxicillin-Clavulanate) Treatment
For most respiratory tract infections, Augmentin should be prescribed for 10-14 days, though shorter courses of 5-7 days are equally effective for acute bacterial sinusitis and may reduce side effects. 1
Treatment Duration by Indication
Acute Bacterial Sinusitis
- Standard duration: 10-14 days until the patient is symptom-free for 7 days 1
- Shorter courses of 5-7 days are equally effective and associated with fewer adverse events, particularly for uncomplicated cases 1
- Assess clinical response at 3-5 days; if improving, continue treatment; if not improving, consider switching antibiotics 1
- Cefuroxime-axetil and cefpodoxime-proxetil have demonstrated efficacy with just 5 days of treatment 1
Lower Respiratory Tract Infections
- Standard duration: 10 days minimum for respiratory infections requiring hospitalization 2
- For acute exacerbations of chronic bronchitis: 7-10 days 3, 4
- 14 days is mandatory for Pseudomonas aeruginosa infections in bronchiectasis 1
Otitis Media
- 10 days is the standard duration for acute otitis media in pediatric patients 5, 6
- The FDA-approved regimen uses 45 mg/kg/day divided every 12 hours for 10 days 5
Urinary Tract Infections
- 6-12 days depending on severity and whether used prophylactically (e.g., before lithotripsy) or therapeutically 7
Key Clinical Decision Points
When to Extend Treatment Beyond Standard Duration
- Partial response at end of initial course: Continue for another 10-14 days 1
- More severe illness: Longer courses may be appropriate 1
- Pseudomonas infections: Always use 14 days 1
- Symptoms persist despite shorter course: Extend to full 10-14 days 1
When Shorter Courses Are Appropriate
- Uncomplicated acute bacterial sinusitis: 5-7 days reduces adverse events without compromising efficacy 1
- Mild bronchiectasis exacerbations: Shorter courses may suffice (though 14 days remains standard) 1
- Patient preference for reduced side effects: Shared decision-making supports shorter duration when clinically appropriate 1
Common Pitfalls to Avoid
Do not stop treatment prematurely based on symptom improvement alone—complete the prescribed course to prevent treatment failure and resistance 1
Reassess at 7 days if no improvement—this is the critical timepoint for determining treatment failure and need to change antibiotics 1
Diarrhea is significantly more common with longer courses—the every-8-hour regimen (500/125 mg) causes more severe diarrhea (2%) than the every-12-hour regimen (875/125 mg, 1%) 5
Geographic resistance patterns matter—in areas with high beta-lactamase-producing organisms, consider that standard amoxicillin may be inadequate, making the clavulanate component of Augmentin essential 8