Augmentin (Amoxicillin-Clavulanate) Dosing and Treatment Protocol
For adults with mild-to-moderate infections, use 500 mg/125 mg three times daily or 875 mg/125 mg twice daily; for respiratory infections specifically, the 875/125 mg twice-daily formulation is preferred. 1
Standard Adult Dosing Regimens
Oral Formulations
Mild-to-Moderate Infections:
- 500 mg amoxicillin/125 mg clavulanate three times daily provides adequate coverage for most community-acquired infections 1
- This dosing is appropriate for uncomplicated skin infections, mild respiratory infections, and urinary tract infections 1
Respiratory Tract Infections (Preferred):
- 875 mg/125 mg twice daily is specifically recommended for acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 1
- Duration for uncomplicated acute bacterial rhinosinusitis is 5-7 days 1
- For pneumonia, continue treatment for 5-7 days if afebrile for 48 hours and clinically stable 1
Skin and Soft Tissue Infections:
- 875 mg/125 mg twice daily for standard infections 1
- 500 mg/125 mg twice daily for animal or human bites 1, 2
- Duration: 5-7 days after clinical improvement 2
Intravenous Formulations
Serious Infections:
- 1.2 g IV every 8 hours for complicated intra-abdominal infections, severe respiratory infections, and severe skin/soft tissue infections 1, 2
- For moderate-to-severe community-acquired pneumonia requiring hospitalization, this three-times-daily dosing provides optimal pharmacodynamic coverage 2
- Duration for intra-abdominal infections: 4-7 days with adequate source control 1
Alternative IV Dosing:
- For intra-abdominal infections in non-critically ill patients: 2 g/0.2 g every 8 hours 2
Pediatric Dosing
Urinary Tract Infections (Ages 2-24 Months):
- 20-40 mg/kg per day (amoxicillin component) divided into 3 doses 3
- Total treatment duration: 7-14 days 3
- Avoid nitrofurantoin in febrile infants, as it does not achieve adequate parenchymal concentrations for pyelonephritis 3
Acute Bacterial Rhinosinusitis:
- 90 mg/6.4 mg/kg per day (high-dose formulation) 2
Recurrent/Persistent Acute Otitis Media:
- 90 mg/6.4 mg/kg per day in two divided doses (Augmentin ES-600 formulation) for children with risk factors for beta-lactamase-producing strains or penicillin-resistant S. pneumoniae 4
Streptococcal Carrier State:
- 40 mg/kg/day (amoxicillin component) divided into three doses for 10 days (maximum 2000 mg amoxicillin per day) 1, 2
Special Clinical Scenarios
Lyme Disease with Cellulitis:
- 500 mg three times daily for 14 days when covering both Lyme disease and bacterial cellulitis 1
Recurrent Streptococcal Pharyngitis:
- 500 mg twice daily for 10 days in adults with multiple recurrent episodes 1
- For chronic carriers: 500 mg (amoxicillin component) twice daily for 10 days 1
Critical Dosing Considerations and Pitfalls
Formulation Substitution Error:
- Never substitute two 250 mg tablets for one 500 mg tablet, as this results in excessive clavulanate dosing and increased gastrointestinal side effects 1
Treatment Duration:
- Complete the full course of therapy to prevent treatment failure and resistance development 1
- For streptococcal infections, minimum 10 days of therapy is required to prevent acute rheumatic fever 1, 2
Drug Interactions:
- Not recommended with probenecid 2
- May increase prothrombin time with oral anticoagulants; monitor INR closely 2
Local Resistance Patterns:
- Know local susceptibility patterns for E. coli and other coliforms before prescribing, particularly for urinary tract infections 3
- Geographic variability in resistance to trimethoprim-sulfamethoxazole and cephalexin affects empiric therapy choices 3
Transition from IV to Oral Therapy
Criteria for Transition: