What is the dosage and treatment duration for Augmentin (amoxicillin and clavulanic acid)?

Augmentin (Amoxicillin-Clavulanate) Dosing and Duration

For adults with respiratory tract infections, use Augmentin 875/125 mg twice daily for standard infections or 2000/125 mg twice daily for severe infections or when antibiotic resistance is likely, treating for 7-10 days; for children, use high-dose formulation of 90 mg/kg/day (amoxicillin component) with 6.4 mg/kg/day clavulanate in two divided doses for most respiratory infections, treating for 10 days. 1, 2

Adult Dosing

Standard Respiratory Infections

• Augmentin 875/125 mg twice daily is the standard adult dose for most respiratory tract infections 2
• Alternative: 500/125 mg every 8 hours for less severe infections 2

High-Dose Regimen for Resistant Organisms

• Use 2000/125 mg twice daily when antibiotic resistance is likely, including: 1

  • Recent antibiotic use within the past 30 days
  • Contact with healthcare environments
  • Prior antibiotic therapy failure
  • High prevalence of resistant bacteria in the community (>10% penicillin-resistant S. pneumoniae)
  • Age >65 years
  • Comorbidities (diabetes, chronic heart/lung/liver/kidney disease)
  • Immunocompromised status

• The high-dose regimen achieves adequate serum concentrations to eradicate penicillin-resistant S. pneumoniae with amoxicillin MICs up to 4-8 mg/L 1

Duration of Therapy - Adults

• 7-10 days for community-acquired pneumonia and most respiratory infections 1
• 10-14 days for sinusitis, or until symptomatically improved for 7 days 1
• 5-7 days for uncomplicated acute bacterial rhinosinusitis 1

Pediatric Dosing

High-Dose Regimen (Preferred for Most Infections)

• 90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate in two divided doses (maximum 4000 mg/day amoxicillin) 1, 3
• This provides a 14:1 ratio of amoxicillin to clavulanate, which minimizes diarrhea while maintaining efficacy 3

Standard-Dose Regimen

• 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours for less severe infections in children ≥12 weeks 1
• 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours for mild infections 1

Age-Based Dosing for Standard Infections

• Birth to 1 year: 2.5 ml of 125/31 suspension three times daily 3
• 1-6 years: 5 ml of 125/31 suspension three times daily 3
• 7-12 years: 5 ml of 250/62 suspension three times daily 3
• ≥12 years or ≥40 kg: Use adult dosing 2

Duration of Therapy - Pediatrics

• 10 days for bacterial pneumonia and most respiratory infections 4, 3
• 10-14 days for acute bacterial rhinosinusitis 1
• Continue for 7 days after the patient becomes free of signs and symptoms 3

Specific Clinical Indications

Community-Acquired Pneumonia

• Children <3 years: Start with amoxicillin alone 80-100 mg/kg/day in three divided doses unless risk factors present 4
• Risk factors requiring amoxicillin-clavulanate (80 mg/kg/day amoxicillin component): 4
  • Incomplete H. influenzae type b vaccination (<3 injections)
  • Concurrent purulent acute otitis media
• Children ≥3 years: Base choice on clinical picture—use amoxicillin for pneumococcal pneumonia, macrolide for atypical pathogens 4

Acute Otitis Media

• High-dose amoxicillin-clavulanate (90/6.4 mg/kg/day) for children who received amoxicillin in the previous 30 days or with otitis-conjunctivitis 1

Acute Bronchiolitis

• Antibiotics generally not indicated (Grade C evidence) 4
• Consider amoxicillin-clavulanate only if fever ≥38.5°C persisting >3 days, purulent acute otitis media, or confirmed pneumonia/atelectasis on chest X-ray 4

Critical Dosing Considerations

Common Pitfalls to Avoid

• Never substitute two 250/125 mg tablets for one 500/125 mg tablet—they contain the same amount of clavulanate (125 mg), making them non-equivalent 2
• Do not use 250/125 mg tablets in children <40 kg due to incorrect amoxicillin:clavulanate ratio 2
• Verify suspension concentration (125/31 vs 250/62) before calculating volume to avoid dosing errors 3
• Underdosing in areas with high penicillin-resistant S. pneumoniae prevalence leads to treatment failure—always use high-dose formulations when resistance is suspected 1

Monitoring and Response

• Evaluate clinical response within 48-72 hours of initiating therapy 1
• If no improvement or worsening after 72 hours, reassess diagnosis, consider atypical pathogens, and evaluate for complications 3

Renal Impairment

• GFR <30 mL/min: Do not use 875/125 mg formulation 2
• GFR 10-30 mL/min: Use 500/125 mg or 250/125 mg every 12 hours 2
• GFR <10 mL/min: Use 500/125 mg or 250/125 mg every 24 hours 2
• Hemodialysis: Dose every 24 hours with additional dose during and at end of dialysis 2

Administration

• Take at the start of a meal to enhance clavulanate absorption and minimize gastrointestinal intolerance 2
• May be taken without regard to meals, but absorption is optimized with food 2