Augmentin (Amoxicillin-Clavulanate) Dosing and Duration
For adults with respiratory tract infections, use Augmentin 875 mg/125 mg twice daily or 500 mg/125 mg three times daily for 7-10 days, escalating to the high-dose formulation 2000 mg/125 mg twice daily when antibiotic resistance is likely. 1
Adult Dosing
Standard regimens:
- Mild to moderate infections: 500 mg/125 mg every 12 hours OR 250 mg/125 mg every 8 hours 1
- Respiratory tract infections or more severe infections: 875 mg/125 mg every 12 hours OR 500 mg/125 mg every 8 hours 1
High-dose regimen (2000 mg/125 mg twice daily) is indicated when: 2
- Recent antibiotic use within the past 30 days
- Contact with healthcare environments
- Previous antibiotic therapy failure
- High community prevalence of resistant bacteria (>10% penicillin-resistant S. pneumoniae)
- Age >65 years or immunocompromised status
- Comorbidities (diabetes, chronic heart/lung/liver/kidney disease)
Duration of therapy:
- Respiratory tract infections: 7-10 days 2
- Sinusitis: 10-14 days or until symptomatically improved for 7 days 2
- Uncomplicated urinary tract infections: 3-7 days 2
Pediatric Dosing
High-dose regimen (90 mg/kg/day of amoxicillin with 6.4 mg/kg/day clavulanate in 2 divided doses) is the preferred formulation for most pediatric respiratory infections. 2, 3
Standard dosing by age (for less severe infections): 3
- <1 year: 2.5 ml of 125/31 suspension three times daily
- 1-6 years: 5 ml of 125/31 suspension three times daily
- 7-12 years: 5 ml of 250/62 suspension three times daily
- ≥12 years: 1 tablet (250/125) three times daily
High-dose indications in children: 3
- Age <2 years
- Daycare attendance
- Recent antibiotic use
- Incomplete H. influenzae type b vaccination (<3 injections)
- Geographic area with high pneumococcal resistance (>10%)
- Concurrent purulent acute otitis media
- Moderate to severe illness
Duration in children:
- Bacterial pneumonia/LRTI: 10 days 4, 3
- Acute bacterial rhinosinusitis: 10-14 days 2
- Acute otitis media: 10 days 3
Critical Dosing Considerations
The high-dose formulation (2000/125 mg for adults, 90/6.4 mg/kg for children) achieves adequate serum concentrations to eradicate penicillin-resistant S. pneumoniae with MICs up to 4-8 mg/L. 2
Common pitfalls to avoid:
- Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet - they contain the same amount of clavulanate (125 mg), making this substitution inappropriate 1
- Verify suspension concentration (125/31 vs 250/62) before calculating volume to prevent dosing errors 3
- Underdosing in areas with high penicillin-resistant S. pneumoniae prevalence leads to treatment failure and promotes resistance 2
- Most upper respiratory tract infections are viral and do not require antibiotics - ensure bacterial infection criteria are met before prescribing 3
Clinical response should be evident within 48-72 hours; if no improvement or worsening occurs, reassess the diagnosis and consider alternative pathogens or complications. 2, 3
Renal Impairment Adjustments
For adults with severe renal impairment: 1
- GFR <30 mL/min: Do not use 875 mg/125 mg formulation
- GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours
- GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours
- Hemodialysis: 500 mg/125 mg or 250 mg/125 mg every 24 hours, with additional dose during and at end of dialysis
Administration
Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance. 1