Augmentin Dosage for Pneumonia
For adults with community-acquired pneumonia, the recommended dosage of Augmentin (amoxicillin/clavulanate) is 875/125 mg orally every 12 hours, or for more severe infections or drug-resistant pathogens, use the pharmacokinetically enhanced formulation 2000/125 mg (Augmentin XR) orally every 12 hours for 5-7 days. 1, 2
Adult Dosing by Severity
Outpatient/Mild-Moderate Pneumonia
- Standard dose: 875/125 mg orally every 12 hours for 5-7 days 1
- Alternative: 500/125 mg orally every 8 hours for respiratory tract infections 1
- Treatment duration of 5-7 days is adequate if the patient is afebrile for at least 48 hours and has no more than one CAP-associated sign of clinical instability 3
Severe Pneumonia or Drug-Resistant Pathogens
- High-dose formulation: 2000/125 mg (Augmentin XR) orally every 12 hours for 7-10 days 2, 4, 5
- This pharmacokinetically enhanced formulation was specifically developed to treat drug-resistant Streptococcus pneumoniae with penicillin MICs up to 4 mg/L and beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis 2, 4
- Clinical trials demonstrate 92-95% success rates with this high-dose regimen, including against penicillin-resistant pneumococcal strains 4, 5
Hospitalized Patients
- Intravenous dosing: 1.2 g (1200 mg) IV every 8 hours 3, 6
- Should be combined with a macrolide (such as azithromycin or clarithromycin) for hospitalized patients to cover atypical pathogens 3, 7
- Switch to oral therapy when clinically stable (afebrile, improving symptoms) 3
Pediatric Dosing (≥3 months)
Standard Dosing
- Every 12-hour regimen (preferred): 45 mg/kg/day of amoxicillin component divided every 12 hours for otitis media, sinusitis, and lower respiratory tract infections 1
- Every 8-hour regimen: 40 mg/kg/day divided every 8 hours 1
- The every 12-hour regimen is preferred as it causes significantly less diarrhea 1
High-Risk or Resistant Infections
- Augmentin ES-600: 90 mg/kg/day (of amoxicillin component) divided into 2 doses for persistent infections or risk factors for drug-resistant pathogens 2
- For children weighing ≥40 kg, use adult dosing recommendations 1
Neonates and Infants <3 months
- 30 mg/kg/day divided every 12 hours based on amoxicillin component 1
- Use the 125 mg/5 mL oral suspension formulation 1
Important Clinical Considerations
Administration
- Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 1
- May be taken without regard to meals, but meal administration is preferred 1
Critical Dosing Warnings
- Do NOT substitute two 250/125 mg tablets for one 500/125 mg tablet—they contain the same amount of clavulanic acid (125 mg) and are not equivalent 1
- Different formulations (tablets vs. chewable tablets) are not interchangeable due to varying clavulanate content 1
When to Use High-Dose Formulations
- Geographic areas with pneumococcal macrolide resistance >25% 7
- Recent antibiotic use within 3 months 7
- Comorbidities (COPD, diabetes, heart disease, renal disease) 7
- Age >65 years or <2 years 3
- Suspected penicillin-resistant S. pneumoniae (penicillin MIC ≥2 mg/L) 3, 2
Combination Therapy Indications
- Hospitalized patients should receive Augmentin plus a macrolide (azithromycin 500 mg daily or clarithromycin 500 mg twice daily) or respiratory fluoroquinolone 3, 7
- Combination therapy improves outcomes in bacteremic pneumococcal pneumonia and severe CAP 3
Common Pitfalls to Avoid
- Underdosing in resistant infections: Standard 875/125 mg may fail against highly resistant pneumococcal strains; use 2000/125 mg formulation when resistance is suspected 2, 5
- Monotherapy in hospitalized patients: Always add macrolide coverage for hospitalized CAP patients 3, 7
- Incorrect formulation substitution: Different Augmentin formulations have varying clavulanate ratios and cannot be interchanged 1
- Inadequate treatment duration: Ensure at least 48 hours of clinical stability before discontinuing therapy 3