Is thrice daily dosing of Augmentin (amoxicillin/clavulanate) for 10 days a suitable treatment regimen?

Augmentin Thrice Daily Dosing for 10 Days

Yes, Augmentin can be dosed three times daily for 10 days and is a well-established regimen supported by multiple high-quality guidelines for various infections, including respiratory tract infections, streptococcal pharyngitis, and chronic rhinosinusitis. 1, 2

Standard Three-Times-Daily Regimens

Adult Dosing

• 500 mg three times daily for 10 days is the standard regimen for mild-to-moderate infections, including acute bacterial rhinosinusitis and respiratory tract infections 1, 2
• Amoxicillin 1500 mg three times daily for 10 days (higher amoxicillin component) has been studied in acute post-viral rhinosinusitis with good efficacy 1
• Amoxicillin 750 mg three times daily for 7 days was effective for maxillary sinusitis in clinical trials 1

Pediatric Dosing

• 40 mg/kg/day of amoxicillin component divided into three doses for 10 days is recommended for chronic Group A streptococcal carriers (maximum 2000 mg amoxicillin per day) 2
• For community-acquired pneumonia in children <3 years, 80-100 mg/kg/day in 3 divided doses for 10 days is recommended by the Infectious Diseases Society of America 3

Clinical Indications for Three-Times-Daily Dosing

Respiratory Infections

• Acute bacterial rhinosinusitis: 500 mg three times daily for 10 days is supported by European Position Paper on Rhinosinusitis 1
• Chronic rhinosinusitis: 500 mg three times daily for 9 days showed comparable efficacy to ciprofloxacin 1

Streptococcal Infections

• Chronic streptococcal carriers with recurrent symptomatic episodes: 500 mg (amoxicillin component) three times daily for 10 days 2
• The 10-day duration is critical to prevent acute rheumatic fever, regardless of clinical improvement 2

Other Infections

• Group A streptococcal pharyngeal carriage eradication in healthcare workers: 500 mg three times daily for 10 days 1

Important Caveats

When NOT to Use Three-Times-Daily Dosing

• For standard acute bacterial rhinosinusitis, the 875/125 mg twice-daily formulation is preferred by the Infectious Diseases Society of America for respiratory infections, with shorter duration (5-7 days) 2
• For uncomplicated skin/soft tissue infections and animal bites, twice-daily dosing (875/125 mg or 500/125 mg) is standard 2

Critical Dosing Errors to Avoid

• Never substitute two 250 mg tablets for one 500 mg tablet, as this results in excessive clavulanate dosing and increased gastrointestinal side effects 2
• The three-times-daily regimen has higher rates of diarrhea compared to twice-daily formulations (34.3% vs 14.3% in pediatric studies) 4

Formulation Considerations

• The FDA label demonstrates that every 12-hour dosing significantly reduces diarrhea compared to every 8-hour dosing in pediatric patients (14.3% vs 34.3%) 4
• Three-times-daily dosing may be necessary when higher total daily amoxicillin doses are required for resistant organisms 5

Clinical Decision Algorithm

Choose three-times-daily dosing when:

1. Treating chronic streptococcal carriers requiring eradication 2
2. Pediatric pneumonia requiring high-dose amoxicillin (80-100 mg/kg/day) 3
3. Following specific guideline recommendations for acute rhinosinusitis when 10-day therapy is indicated 1

Choose twice-daily dosing (875/125 mg) when:

1. Treating standard respiratory tract infections in adults 2
2. Minimizing gastrointestinal side effects is a priority 4
3. Improving compliance with less frequent dosing 5

Complete the full 10-day course for streptococcal infections to prevent acute rheumatic fever, even if symptoms resolve earlier 2