What is the recommended dosage of Augmentin (amoxicillin/clavulanate) for uncomplicated diverticulitis?

Augmentin Dosing for Uncomplicated Diverticulitis

For uncomplicated diverticulitis, most immunocompetent patients do NOT require antibiotics at all, but when antibiotics are indicated, Augmentin (amoxicillin-clavulanate) 875/125 mg orally twice daily for 4-7 days is the recommended regimen. 1

Critical First Decision: Does This Patient Actually Need Antibiotics?

The most important clinical decision is determining whether antibiotics are necessary, as multiple high-quality randomized controlled trials, including the DIABOLO trial with 528 patients, demonstrate that antibiotics neither accelerate recovery nor prevent complications or recurrence in uncomplicated cases. 1

Reserve antibiotics ONLY for patients with these specific high-risk features: 1, 2

• Immunocompromised status (chemotherapy, high-dose steroids, organ transplant)
• Age >80 years
• Pregnancy
• Persistent fever or chills despite supportive care
• Increasing leukocytosis or WBC >15 × 10⁹ cells/L
• Elevated CRP >140 mg/L
• Refractory symptoms or vomiting
• Inability to maintain oral hydration
• Significant comorbidities (cirrhosis, chronic kidney disease, heart failure, poorly controlled diabetes)
• CT findings of fluid collection, longer segment of inflammation, or pericolic extraluminal air
• ASA score III or IV
• Symptoms lasting >5 days prior to presentation

Specific Augmentin Dosing Regimens

Outpatient Oral Therapy

Augmentin 875/125 mg orally twice daily for 4-7 days is the recommended alternative to the first-line regimen of ciprofloxacin plus metronidazole. 1, 3, 2 This dosing was validated in the DIABOLO trial and provides comprehensive coverage for gram-positive, gram-negative, and anaerobic bacteria involved in colonic infections. 1

Inpatient IV-to-Oral Transition

For hospitalized patients requiring initial IV therapy: 1

• Initial IV therapy: Amoxicillin-clavulanate 1200 mg IV four times daily for at least 48 hours
• Transition criteria: Once patient tolerates oral intake, temperature <100.4°F, pain score <4/10, and can maintain self-care
• Oral continuation: Augmentin 625 mg orally three times daily to complete 4-7 days total duration

Transition to oral antibiotics should occur as soon as possible to facilitate earlier discharge, as hospital stays are actually shorter (2 vs 3 days) in observation groups compared to prolonged antibiotic-treated patients. 1

Duration of Therapy

Standard duration: 4-7 days for immunocompetent patients 1, 3, 2

Extended duration: 10-14 days ONLY for immunocompromised patients (those on corticosteroids, chemotherapy, or immunosuppression for organ transplantation who are at major risk for perforation and death). 1

Alternative Regimens When Augmentin Is Not Appropriate

If the patient has a true penicillin allergy, the first-line alternative is ciprofloxacin 500 mg orally twice daily PLUS metronidazole 500 mg orally three times daily for 4-7 days. 1, 3

For inpatient IV therapy when oral intake is not tolerated, use ceftriaxone PLUS metronidazole OR piperacillin-tazobactam. 1, 2

Outpatient Management Criteria

Augmentin outpatient therapy is appropriate when patients meet ALL of these criteria: 1

• Able to tolerate oral fluids and medications
• Temperature <100.4°F
• Pain score <4/10 (controlled with acetaminophen only)
• No significant comorbidities or frailty
• Adequate home support and ability to maintain self-care at pre-illness level
• No signs of systemic inflammatory response or sepsis

Critical Monitoring and Follow-Up

Mandatory re-evaluation within 7 days is required, with earlier assessment if symptoms worsen. 1 Patients should return immediately for fever >101°F, severe uncontrolled pain, persistent nausea/vomiting, or inability to eat or drink. 1

Common Pitfalls to Avoid

Do not automatically prescribe antibiotics for all diverticulitis cases - this contributes to antibiotic resistance without clinical benefit, as the evidence shows no difference in outcomes between antibiotic and non-antibiotic approaches for uncomplicated cases without risk factors. 1, 4

Do not extend antibiotics beyond 4-7 days for immunocompetent patients - the longer 10-14 day duration is specifically reserved for immunocompromised patients only. 1

Do not stop antibiotics early even if symptoms improve - this may lead to incomplete treatment and recurrence. 1

Do not apply the "no antibiotics" approach to complicated diverticulitis (Hinchey 1b or higher) - the evidence supporting observation without antibiotics specifically excluded patients with abscesses and higher Hinchey stages. 1