Duration of Augmentin (Amoxicillin-Clavulanate) Treatment
For most common infections requiring Augmentin, the standard treatment duration is 10-14 days, with respiratory tract infections typically requiring the full 14 days and less severe infections potentially being treated for 7-10 days. 1, 2
Standard Treatment Durations by Indication
Respiratory Tract Infections
- Acute bacterial sinusitis: 10-14 days is the standard recommendation from multiple major guidelines 1, 3, 2
- Bronchiectasis exacerbations: 14 days is mandatory, particularly when Pseudomonas aeruginosa is involved 4
- Community-acquired pneumonia in children: 10 days for pneumococcal pneumonia; at least 14 days for atypical pathogens 4
- Acute exacerbations of chronic bronchitis: 5-7 days may be sufficient for mild-moderate cases, though traditional courses are 7-10 days 4, 5
Other Common Infections
- Acute otitis media: 10 days is the studied and recommended duration 6
- Upper respiratory tract infections: 5-7 days for uncomplicated cases 7
- Urinary tract infections: Duration varies by severity but typically 7-14 days 6
Critical Treatment Principles
Assessment of Response
- Evaluate clinical response at 72 hours (3 days) after starting therapy 1, 3, 2
- If no improvement or worsening occurs, switch to an alternative antibiotic or reevaluate the diagnosis 1, 2
- If partial improvement is seen, continue the full 10-14 day course 1, 3
- Treatment should continue until the patient has been symptom-free for 7 days, which typically aligns with the 10-14 day course 1, 2
Dosing Considerations
- Standard adult dose: 875/125 mg twice daily 1, 3, 6
- High-dose regimen: 2,000/125 mg twice daily for resistant organisms or treatment failure 1, 5
- For severe respiratory infections, use the 875/125 mg formulation every 12 hours rather than lower doses 6
When to Use Longer Courses (14 Days)
Always use the full 14-day course in these scenarios:
- Infections with Pseudomonas aeruginosa 4
- Chronic rhinosinusitis or acute exacerbations 1, 2
- Frontal, ethmoidal, or sphenoidal sinusitis (more serious sinus infections) 2
- Patients with suspected resistant organisms 1, 2
- Recent antibiotic use within the past 4-6 weeks 1, 2
- Moderate to severe disease presentation 1, 2
When Shorter Courses May Be Appropriate
5-7 day courses can be considered for:
- Mild to moderate community-acquired pneumonia in adults who achieve clinical stability (afebrile for 48 hours with stable vital signs) 4
- Uncomplicated upper respiratory tract infections 7
- Acute exacerbations of chronic bronchitis in patients without resistant organisms 5
However, the French guidelines suggest 7-10 days for acute maxillary sinusitis, representing a middle ground 4, 2
Common Pitfalls to Avoid
- Do not stop treatment early when symptoms improve - this leads to relapse and promotes antibiotic resistance 2
- Do not arbitrarily shorten the course below guideline recommendations, as this may result in treatment failure 2
- Do not use standard-dose therapy in high-resistance areas or for patients with recent antibiotic exposure - use high-dose regimens instead 1, 2
- Do not substitute different formulations - the 250/125 mg tablets contain different clavulanate ratios than 500/125 mg tablets and are not interchangeable 6
Special Populations
Pediatric Patients
- Children weighing ≥40 kg should receive adult dosing 6
- For acute otitis media, the recommended duration is 10 days regardless of age 6
- The every 12-hour regimen is preferred over every 8-hour dosing due to significantly lower diarrhea rates (14% vs 34%) 6