Augmentin Dosage in Renal Impairment
For patients with impaired renal function, standard Augmentin dosing (500 mg every 12 hours or 250 mg every 8 hours) can be used when GFR is >30 mL/min, but dose reduction or interval extension is mandatory when GFR falls below 30 mL/min. 1
Standard Dosing for Normal to Mild Renal Impairment
- Patients with GFR >30 mL/min do not require dose adjustment and can receive standard dosing regimens based on infection severity 2, 1
- For mild to moderate infections: 500 mg every 12 hours or 250 mg every 8 hours 1
- For severe infections: 875 mg every 12 hours or 500 mg every 8 hours 1
- The 875 mg dose formulation should NOT be used in patients with GFR <30 mL/min 1
Dosage Adjustments for Moderate to Severe Renal Impairment
GFR 10-30 mL/min (Moderate Impairment)
- Reduce dose to 500 mg or 250 mg every 12 hours, depending on infection severity 1
- This represents approximately a 50% dose reduction or doubling of the dosing interval compared to standard regimens 2
GFR <10 mL/min (Severe Impairment)
- Reduce dose to 500 mg or 250 mg every 24 hours, depending on infection severity 1
- This represents a 25-50% reduction from normal dosing to prevent drug accumulation 2
Hemodialysis Patients
- Administer 500 mg or 250 mg every 24 hours (based on infection severity) as the baseline regimen 1
- Give an additional dose both during and at the end of each dialysis session to compensate for drug removal 1
- Always administer the dose after dialysis to avoid premature drug removal and ensure adequate exposure 3, 2
- Post-dialysis dosing is critical—administering before dialysis wastes medication and leaves patients undertreated 2
Critical Monitoring Considerations
- Patients with borderline renal function may require 24-hour urine collection to accurately define the degree of impairment before making regimen changes 2
- Close monitoring for adverse effects is warranted, as drug accumulation can occur with any degree of renal insufficiency 2
- Reassess renal function regularly, particularly in unstable patients, to adjust dosing appropriately 2
Common Pitfalls to Avoid
- Never use the 875 mg formulation in patients with GFR <30 mL/min—this is explicitly contraindicated and can lead to drug accumulation and toxicity 1
- Do not assume all antibiotics require the same degree of dosage adjustment—individualized adjustments based on specific drug properties are necessary 2
- Avoid administering doses before hemodialysis sessions, as this leads to subtherapeutic levels and treatment failure 3, 2
- Do not reduce the dosing interval without also considering dose reduction in severe renal impairment—both parameters must be adjusted 1
Administration Guidance
- Take Augmentin at the start of a meal to minimize gastrointestinal intolerance 1
- Continue treatment for a minimum of 48-72 hours beyond symptom resolution or evidence of bacterial eradication 1
- For Streptococcus pyogenes infections, ensure at least 10 days of treatment to prevent acute rheumatic fever 1