Augmentin Dosing for Bacterial Infections
For most common bacterial infections in adults, Augmentin 875/125 mg twice daily for 7-10 days is the standard regimen, while children require weight-based dosing of 45 mg/kg/day (amoxicillin component) divided twice daily for moderate-to-severe infections. 1, 2
Adult Dosing by Infection Type
Respiratory Tract Infections
- Standard dose: 875/125 mg twice daily for respiratory infections including acute bacterial rhinosinusitis, community-acquired pneumonia, and acute exacerbations of chronic bronchitis 1
- Duration: 5-7 days for uncomplicated acute bacterial rhinosinusitis; 7-10 days for pneumonia 1, 3
- High-dose regimen: 2000/125 mg twice daily when antibiotic resistance is likely (recent antibiotic use within 30 days, healthcare contact, prior treatment failure, high community resistance prevalence, age >65 years, or comorbidities) 1, 3
Skin and Soft Tissue Infections
- Standard dose: 875/125 mg twice daily 1, 4
- Animal/human bites: 500/125 mg twice daily 1
- Duration: 7-10 days 4
- Severe infections (IV): 1.2 g IV every 8 hours 1
Urinary Tract Infections
- Pediatric (2-24 months): 20-40 mg/kg/day (amoxicillin component) in 3 doses 5
- Duration: 7-14 days for febrile UTIs in infants; 3-7 days for uncomplicated UTIs in adults 5, 3
Streptococcal Infections
- NOT first-line: Penicillin V or amoxicillin alone are preferred for acute Group A streptococcal pharyngitis 1
- Chronic carriers with recurrent episodes: 500 mg (amoxicillin component) twice daily for 10 days in adults; 40 mg/kg/day divided three times daily for 10 days in children (maximum 2000 mg/day) 1
- Critical: Complete full 10-day course to prevent acute rheumatic fever 1, 2
Pediatric Dosing (≥3 months and <40 kg)
Standard Dosing Framework
- Mild-to-moderate infections: 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours 2
- Severe infections or lower respiratory tract: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 2
- High-dose formulation: 90 mg/kg/day (amoxicillin) with 6.4 mg/kg/day (clavulanate) in two divided doses for resistant infections 3
Age-Specific Considerations
- Infants <3 months: Maximum 30 mg/kg/day divided every 12 hours due to immature renal function 2
- Duration: Minimum 48-72 hours beyond symptom resolution or bacterial eradication 2
Critical Dosing Considerations
Renal Impairment
- GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 2
- GFR <10 mL/min: 500 mg or 250 mg every 24 hours 2
- Hemodialysis: 500 mg or 250 mg every 24 hours; administer additional dose during and at end of dialysis 2
- Critical warning: Patients with GFR <30 mL/min should NOT receive the 875 mg dose 2
Administration Guidelines
- Take at the start of meals to minimize gastrointestinal intolerance 2
- Oral suspension: Shake well before use; discard unused portion after 14 days; refrigeration preferable but not required 2
Common Pitfalls to Avoid
Formulation Errors
- Never substitute two 250 mg tablets for one 500 mg tablet as this results in excessive clavulanate dosing and increased diarrhea risk 1
- The 875/125 mg formulation has lower clavulanate content than 500/125 mg three times daily, resulting in better gastrointestinal tolerance 4
Resistance Considerations
- In areas with >10% prevalence of penicillin-resistant Streptococcus pneumoniae, always use high-dose formulations (2000/125 mg twice daily for adults or 90 mg/kg/day for children) 3
- Know local resistance patterns for E. coli to trimethoprim-sulfamethoxazole and cephalexin, as geographic variability is substantial 5
Duration Errors
- Minimum treatment duration: 48-72 hours beyond symptom resolution 2
- Streptococcal infections: Always complete 10 days to prevent acute rheumatic fever, regardless of clinical improvement 1, 2
- Courses of 1-3 days for febrile UTIs are inferior and should be avoided 5
Clinical Response Monitoring
- Evaluate clinical response within 48-72 hours of initiating therapy to determine need for alternative management 3