What is the recommended treatment with Augmentin (amoxicillin-clavulanate) for a 16-year-old patient?

Augmentin Dosing for a 16-Year-Old Patient

For a 16-year-old patient, Augmentin should be dosed according to adult recommendations: 875 mg/125 mg twice daily for respiratory tract infections or 500 mg/125 mg three times daily for less severe infections, with treatment duration of 10-14 days depending on the specific indication. 1

Standard Dosing Regimens

At 16 years of age, this patient has reached the threshold for adult dosing (≥40 kg body weight or ≥12 years of age). 1

For Respiratory Tract Infections

• Preferred regimen: 875 mg/125 mg tablet every 12 hours 1
• Alternative: 500 mg/125 mg tablet every 8 hours 1
• These higher doses are specifically indicated for more severe infections and respiratory tract involvement 1

For Less Severe Infections

• Standard regimen: 500 mg/125 mg tablet every 12 hours 1
• Alternative: 250 mg/125 mg tablet every 8 hours 1

Indication-Specific Guidance

Acute Bacterial Sinusitis

• Dose: 875 mg/125 mg twice daily for 10-14 days 2
• This regimen provides coverage against β-lactamase-producing H. influenzae, M. catarrhalis, and penicillin-resistant S. pneumoniae 2, 3
• Evaluate treatment response after 72 hours; if no improvement or worsening, consider switching antibiotics or reevaluating the diagnosis 2

Community-Acquired Pneumonia

• Dose: 875 mg/125 mg twice daily for 10 days 4
• For adolescents with skeletal maturity, this provides adequate coverage for typical bacterial pathogens 4
• The extended-release formulation (2000 mg/125 mg twice daily) is available for drug-resistant pathogens in the United States 3, 5

Acute Otitis Media (if applicable)

• Dose: 875 mg/125 mg twice daily for 10 days 6
• Though less common in adolescents, this dosing provides adequate coverage if needed 7

Critical Dosing Considerations

Important Tablet Equivalencies

• Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as both contain the same amount of clavulanate (125 mg), making them non-equivalent 1
• The 250 mg/125 mg tablet should not be used until the patient weighs at least 40 kg 1

Treatment Duration

• Standard duration: 10 days for most respiratory infections 4
• Shorter courses may be effective for milder disease, but 10-14 days is the evidence-based standard 4, 2
• Continue treatment for the full prescribed duration to prevent incomplete eradication and potential relapse 2

Renal Function Considerations

If the patient has impaired renal function:

• GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours 1
• GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours 1
• Do NOT use the 875 mg/125 mg dose if GFR <30 mL/min 1

Common Pitfalls to Avoid

• Underdosing: Using pediatric formulations or lower doses in a 16-year-old will result in subtherapeutic levels and treatment failure 6
• Inappropriate indication: Ensure the infection is bacterial, not viral; antibiotics for viral upper respiratory infections increase adverse effects without benefit and promote resistance 2
• Incomplete course: Not completing the full antibiotic course leads to incomplete eradication and potential relapse 2
• Wrong formulation: The extended-release formulation (Augmentin XR) is specifically for resistant pathogens and should not be used as first-line therapy 5

Adverse Effects and Monitoring

• Most common adverse events are mild gastrointestinal disturbances, particularly diarrhea 7, 8
• The twice-daily regimen (875 mg/125 mg) is associated with less diarrhea than three-times-daily dosing 1, 8
• Clinical improvement should be evident within 48-72 hours; if not, reassess the diagnosis 2, 6