What is the recommended dosage of Augmentin (amoxicillin-clavulanate) for treating urinary tract infections (UTIs)?

Augmentin Dosage for UTI

For uncomplicated lower urinary tract infections (cystitis) in adults, use Augmentin 875 mg/125 mg orally every 12 hours for 5-7 days. 1

Adult Dosing by UTI Type

Uncomplicated Cystitis

• 875 mg/125 mg orally every 12 hours for 5-7 days is the standard regimen 1
• This dosing is supported by FDA clinical trial data showing comparable efficacy to the more frequent 500 mg/125 mg every 8 hours regimen, with significantly lower rates of severe diarrhea (1% vs 2%) 2
• E. coli demonstrates high susceptibility to amoxicillin-clavulanate, making it a first-choice option 1

Complicated UTIs and Pyelonephritis

• 875 mg/125 mg orally every 12 hours for 7-14 days for complicated infections 1, 2
• Treatment duration should be individualized based on clinical response, with most patients requiring 7-10 days 1
• For severe pyelonephritis or prostatitis, consider alternative first-line agents like ceftriaxone/cefotaxime or ciprofloxacin instead 1

Catheter-Associated UTIs

• 7-14 days of treatment for most patients with catheter-associated UTIs 1
• Remove the catheter as soon as clinically appropriate 1
• A 3-day regimen may be considered for younger women with mild CA-UTI after catheter removal 1

Monitoring and Treatment Failure

Clinical Response Assessment

• Expect defervescence within 72 hours of initiating therapy 1
• If no clinical improvement by 72 hours, consider treatment extension and urologic evaluation 1
• Lack of response suggests either a resistant organism or alternative diagnosis 1

Common Pitfalls to Avoid

• Do not use Augmentin for asymptomatic bacteriuria 1
• Plain amoxicillin has 75% median resistance and should not be used 1
• Always consider local antimicrobial resistance patterns when selecting empiric therapy 1
• Perform susceptibility testing when possible to adjust therapy accordingly 1

Resistance Considerations

When to Consider Alternatives

• For multidrug-resistant organisms (ESBL-producing or carbapenem-resistant), alternative agents are required 3, 1
• Amoxicillin-clavulanate remains effective due to high E. coli susceptibility, unlike plain amoxicillin 1
• Geographic resistance patterns vary; always consider local antibiograms 3

Penicillin Allergy

• Alternative agents should be selected for patients with documented penicillin allergies 3

Adverse Effects

• Diarrhea is the most common adverse effect (15% incidence with 875 mg/125 mg every 12 hours) 2
• The every 12 hours regimen has significantly lower rates of severe diarrhea compared to more frequent dosing 2