Augmentin Dosing for Recurrent Streptococcal Infections

For recurrent streptococcal pharyngitis in adults, Augmentin should be dosed at 500 mg (amoxicillin component) twice daily for 10 days. 1, 2

Key Dosing Recommendations

The recommended dose is 500 mg twice daily for 10 days for chronic streptococcal carriers with recurrent symptomatic episodes 1, 2
This dosing specifically targets the amoxicillin component of the combination 1
The full 10-day course must be completed to prevent acute rheumatic fever, regardless of symptom improvement 1, 2

The recommended dose is 40 mg/kg/day of the amoxicillin component divided into three doses (maximum 2000 mg amoxicillin per day) for 10 days 1, 2
This higher dosing strategy helps eradicate streptococci that are more difficult to eliminate from the pharynx in chronic carriers 1

Augmentin is NOT first-line therapy for standard acute streptococcal pharyngitis - penicillin V or amoxicillin alone remain the preferred initial treatments due to their narrow spectrum, minimal adverse effects, and low cost 1, 2
Augmentin is specifically indicated for chronic carriers with recurrent symptomatic episodes because the clavulanate component helps overcome beta-lactamase-producing bacteria that may be present in tonsillar tissue and contribute to treatment failure 1, 3
In one prospective randomized study, Augmentin achieved 100% eradication of Group A streptococci compared to only 70% with penicillin alone, and significantly reduced recurrence rates (11% vs 58% over one year) 3

Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet - this results in excessive clavulanate dosing (250 mg vs 125 mg) 1, 4
Both formulations contain the same amount of clavulanic acid (125 mg), making them non-interchangeable 4

The minimum duration is 10 days for any streptococcal infection to prevent acute rheumatic fever 1, 2
Patients become non-contagious after 24 hours of antibiotic therapy 2

If the patient has a documented penicillin allergy, consider these alternatives instead of Augmentin:

Cephalexin: 500 mg twice daily for 10 days (avoid if immediate-type hypersensitivity) 2
Clindamycin: 300 mg three times daily for 10 days (safe for immediate-type hypersensitivity) 2
Azithromycin: 500 mg on day 1, then 250 mg daily for 4 days (consider local resistance patterns) 2

Do not use Augmentin as first-line therapy for uncomplicated acute strep pharyngitis - reserve it for recurrent cases or treatment failures 1, 2
Do not shorten the 10-day course even if symptoms resolve earlier - this is essential for preventing rheumatic fever 1, 2
Do not confuse dosing formulations - the clavulanate content varies between tablet strengths and is not proportional to the amoxicillin content 4
Consider beta-lactamase-producing organisms as a cause of recurrent infections - this is where Augmentin provides specific benefit over amoxicillin alone 3