What is the recommended dose of Augmentin (amoxicillin/clavulanate) for an adult weighing 67 kg with otitis media?

Augmentin Dosing for Adult Otitis Media

For an adult weighing 67 kg with otitis media, prescribe Augmentin 875 mg/125 mg twice daily for 10 days, which is the standard dose for respiratory tract infections including otitis media. 1

Standard Adult Dosing

• The FDA-approved dose for adults with respiratory tract infections is 875 mg/125 mg every 12 hours for more severe infections, or 500 mg/125 mg every 8 hours as an alternative 1
• For standard otitis media in adults, the 875 mg/125 mg twice-daily formulation is preferred as it provides adequate coverage while improving compliance compared to three-times-daily dosing 1
• The recommended treatment duration is 10 days based on clinical trial data for otitis media 1

Weight-Based Considerations

• At 67 kg, this patient falls well within the standard adult dosing range and does not require weight-based calculations 1
• The 875 mg/125 mg twice-daily dose provides approximately 26 mg/kg/day of amoxicillin, which is appropriate for respiratory tract infections 1

Alternative Dosing Options

• If the patient has difficulty swallowing tablets, liquid suspension formulations (400 mg/57 mg per 5 mL) can substitute for the 875 mg/125 mg tablet 1
• The 500 mg/125 mg every 8 hours regimen is equally effective but requires three daily doses, which may reduce compliance 1
• Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as they contain the same amount of clavulanic acid (125 mg) and are not equivalent 1

Clinical Efficacy Evidence

• Pivotal trials demonstrated comparable efficacy between 875 mg/125 mg twice daily and 500 mg/125 mg three times daily for respiratory tract infections, with similar clinical success rates 1
• The twice-daily regimen showed significantly less severe diarrhea (1% vs 2%) compared to the three-times-daily regimen 1
• Amoxicillin-clavulanate provides coverage against the most common otitis media pathogens including Streptococcus pneumoniae (including penicillin-resistant strains), Haemophilus influenzae, and Moraxella catarrhalis 2

Important Clinical Considerations

• Reassess the patient if no clinical improvement occurs after 48-72 hours of therapy 3
• If the patient has received antibiotics in the previous 4-6 weeks, amoxicillin-clavulanate is more appropriate than amoxicillin alone due to higher risk of resistant organisms 3
• Patients with renal impairment (GFR <30 mL/min) should not receive the 875 mg/125 mg dose and require dose adjustment 1

Common Pitfalls to Avoid

• Do not use first-generation cephalosporins as alternatives, as they have poor coverage for H. influenzae 4
• The evidence provided regarding streptococcal pharyngitis dosing (40 mg/kg/day in three doses) 4 is not applicable to adult otitis media, which requires the standard respiratory tract infection dosing 1
• Ensure adequate hydration and take with food to minimize gastrointestinal side effects, particularly diarrhea 1