What is the recommended dosage of Augmentin (amoxicillin/clavulanate) for an adult patient with a typical urinary tract infection (UTI)?

Augmentin Dosing for Urinary Tract Infections

For uncomplicated UTIs in adults, Augmentin 875 mg/125 mg twice daily for 3-5 days is appropriate, though it is not recommended as first-line empiric therapy according to current European guidelines. 1

Key Dosing Recommendations by Clinical Scenario

Uncomplicated UTI (Adult)

• Dose: 875 mg/125 mg (amoxicillin/clavulanate) twice daily 1
• Duration: 3-5 days 1, 2
• Important caveat: Short-course therapy (3 days) with amoxicillin/clavulanate has demonstrated cure rates of 92.8% in uncomplicated lower UTIs 2

Complicated UTI (Adult)

• Dose: 875 mg/125 mg twice daily 1
• Duration: 5-10 days based on clinical response 1
• Alternative dosing: 375 mg three times daily has been used successfully in clinical trials 3, 4

Recurrent UTI (Adult)

• Dose: 250 mg amoxicillin/125 mg clavulanate (one tablet) every 8 hours 5
• Duration: 7 days 5
• Efficacy: Microbiological cure rates of 84% at 1 week and 67% at 1 month post-treatment 5

Pediatric Dosing

• Dose: 20-40 mg/kg/day of the amoxicillin component, divided into 3 doses 1
• High-dose formulation: 90 mg/kg/day with 6.4 mg/kg/day clavulanate in two divided doses for resistant organisms 6, 7

Critical Limitations and When NOT to Use Augmentin

Augmentin should not be used as empiric first-line therapy for UTIs without considering local resistance patterns and guideline recommendations. 1, 8

First-Line Alternatives Preferred

• European Association of Urology guidelines do not recommend Augmentin for empiric treatment of either uncomplicated or complicated UTIs 1
• Preferred empiric agents: Fluoroquinolones (ciprofloxacin, levofloxacin) and cephalosporins (ceftriaxone, cefepime) are recommended instead 8
• Fluoroquinolones should only be used when local resistance is <10% 8

Specific Contraindications

• Do not use for asymptomatic bacteriuria 1
• Do not use for multidrug-resistant organisms without documented susceptibility 1
• Do not use empirically for pyelonephritis or severe complicated UTIs 1, 8

When Augmentin IS Appropriate

Culture-Directed Therapy

• Use only when susceptibility testing confirms sensitivity 1
• Particularly valuable for multiply resistant bacteria that remain susceptible 3
• Success rate of approximately 70% for amoxicillin-resistant organisms when clavulanate is added 3

Patient Populations Where It May Be Considered

• Patients with recurrent UTIs and known susceptibility patterns 5
• Complicated UTIs in patients over 65 years or males with underlying risk conditions (10-day course) 2
• Perioperative prophylaxis (before lithotripsy or adenomectomy): 6-9 days with 85.7% normalization of indices 4

Common Pitfalls to Avoid

• Resistance patterns: Local antimicrobial resistance must guide therapy selection 1
• Duration errors: Do not use 10-day courses for uncomplicated UTIs when 3-5 days is sufficient 1, 2
• Empiric use in severe infections: For severe UTIs requiring IV therapy, start with ceftriaxone 1-2 g IV once daily or fluoroquinolones, not oral Augmentin 8
• Ignoring guidelines: The European Urology guidelines specifically recommend against Augmentin as first-line empiric therapy 1

Tolerability Profile

• Side effects are mild and reported in approximately 20% of patients 5
• Gastrointestinal effects are minimal 3
• Treatment interruption due to side effects is rare 5
• Well tolerated even in patients with chronic renal insufficiency (glomerular filtration 55-70 mL/min) 4