IV Augmentin Dosing and Administration
For severe infections requiring IV Augmentin, administer 1.2 g (1000 mg amoxicillin/200 mg clavulanate) intravenously every 8 hours, with treatment duration of 4-7 days for most serious infections when adequate source control is achieved. 1
Standard IV Dosing Protocol
The recommended IV dose is 1.2 g every 8 hours for most serious infections, including:
- Complicated intra-abdominal infections 1
- Severe respiratory infections 1
- Severe skin and soft tissue infections 1
For necrotizing infections and mixed polymicrobial infections, ampicillin-sulbactam (the IV equivalent formulation) is dosed at 1.5-3.0 g every 6-8 hours, typically combined with clindamycin 600-900 mg every 8 hours and ciprofloxacin 400 mg every 12 hours for optimal coverage 2. Alternatively, piperacillin-tazobactam 3.37 g every 6-8 hours can be used 2.
Critical Administration Considerations
Loading doses are essential in critically ill patients with severe sepsis or septic shock to overcome the "third spacing phenomenon" and ensure adequate tissue penetration 2. The standard 1.2 g dose serves as an appropriate loading dose for hydrophilic beta-lactams like amoxicillin-clavulanate 2.
Extended or prolonged infusions should be considered for beta-lactam antibiotics to maximize time above the minimum inhibitory concentration (MIC), though definitive evidence for superiority remains mixed 2. For IV Augmentin, this means infusing each dose over 30-60 minutes rather than as a rapid bolus.
Treatment Duration Algorithm
Duration depends on infection source and clinical response:
- Intra-abdominal infections: 4-7 days with adequate source control 1
- Pneumonia: 5-7 days if afebrile for 48 hours and clinically stable 1
- Skin/soft tissue infections: 7-10 days depending on severity 1
- Necrotizing infections: Continue until clinical improvement with source control, typically 7-14 days 2
Antimicrobial therapy should be discontinued within 24 hours after cholecystectomy for acute cholecystitis unless infection extends beyond the gallbladder wall 2.
Pediatric IV Dosing
For children requiring IV therapy, ampicillin-sulbactam is dosed at 200 mg/kg/day of the ampicillin component, divided every 6 hours 2. Alternative regimens include piperacillin-tazobactam 200-300 mg/kg/day of the piperacillin component every 6-8 hours 2.
Special Populations and Adjustments
Daily reassessment of the antimicrobial regimen is mandatory because pathophysiological changes in critically ill patients significantly affect drug availability and clearance 2.
Renal function must be monitored closely, as beta-lactam dosing requires adjustment in renal impairment to prevent accumulation while maintaining therapeutic levels 2.
Avoid concurrent aminoglycosides when possible in patients with renal dysfunction to minimize nephrotoxicity risk 1.
Common Pitfalls to Avoid
- Do not use oral formulations for severe infections requiring IV therapy - the bioavailability and tissue penetration are inadequate for serious infections 1
- Do not substitute two 250 mg tablets for one 500 mg tablet in oral formulations, as this results in excessive clavulanate dosing 1
- Do not delay source control procedures - antibiotics alone are insufficient without drainage, debridement, or surgical intervention for abscesses and necrotizing infections 2, 3
- Do not empirically cover MRSA or vancomycin-resistant enterococci unless the patient has specific risk factors such as known colonization, healthcare-associated infection, or prior treatment failure 2