What is the recommended dosing of Augmentin (amoxicillin-clavulanate) for a typical adult patient with normal renal function and no significant medical history?

Augmentin Dosing for Adults with Normal Renal Function

For adults with normal renal function, the standard Augmentin dosing is 500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections or lower respiratory tract infections. 1

Standard Dosing Regimens

Mild to Moderate Infections

• Ear/nose/throat, skin/skin structure, or genitourinary tract infections: 500 mg every 12 hours OR 250 mg every 8 hours 1
• These dosing schedules apply to most community-acquired infections in patients without significant comorbidities 1

Severe Infections

• Severe infections or lower respiratory tract infections: 875 mg every 12 hours OR 500 mg every 8 hours 1
• The higher dose regimen provides enhanced coverage against pathogens with reduced susceptibility 1

Administration Guidelines

• 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, treat for at least 10 days to prevent acute rheumatic fever 1

Enhanced Formulations for Resistant Pathogens

High-Dose Extended Release (Augmentin XR)

• Dosing: 2000 mg/125 mg twice daily 2, 3
• Indications: Community-acquired respiratory tract infections caused by drug-resistant Streptococcus pneumoniae (with penicillin MICs ≥2 mcg/mL but ≤4 mcg/mL), beta-lactamase-producing Haemophilus influenzae, or Moraxella catarrhalis 2, 3
• This formulation maintains plasma amoxicillin concentrations above 4 mcg/mL for approximately 49% of the dosing interval, providing enhanced activity against resistant pathogens 3

Special Clinical Scenarios

H. pylori Eradication (Triple Therapy)

• Dosing: 1 gram amoxicillin with 500 mg clarithromycin and 30 mg lansoprazole, all given twice daily for 14 days 1

H. pylori Eradication (Dual Therapy)

• Dosing: 1 gram amoxicillin with 30 mg lansoprazole, both given three times daily for 14 days 1

Clinical Efficacy Evidence

• Augmentin demonstrates approximately 70% success rates for amoxicillin-resistant organisms in urinary tract infections 4
• The combination shows high bacteriological and clinical efficacy in respiratory tract infections over more than 20 years of clinical use 2
• The drug exhibits a low propensity to select resistance mutations, contributing to its sustained clinical utility 2

Common Pitfalls to Avoid

• Do not use the 875 mg dose in patients with severe renal impairment (GFR <30 mL/min), as dose reduction is required 1
• Avoid skipping the meal-time administration, as this significantly increases gastrointestinal side effects 1
• Do not discontinue therapy prematurely when symptoms resolve; continue for the full 48-72 hours beyond clinical improvement 1
• For infections requiring several weeks of treatment, clinical and bacteriological follow-up may be necessary for several months after therapy cessation 1

Tolerability Profile

• Augmentin is generally well tolerated with minimal gastrointestinal side effects when taken with food 4
• The high-dose formulations (Augmentin XR) have a tolerability profile comparable to conventional formulations 2, 3