Augmentin Dosing for Pneumonia in Long-Term Care Settings
For elderly patients with pneumonia in long-term care facilities, prescribe Augmentin 875 mg/125 mg twice daily combined with azithromycin 500 mg on day 1 then 250 mg daily for 7 days, with mandatory dose reduction to 500 mg/125 mg every 12 hours if creatinine clearance is below 30 mL/min. 1, 2
Standard Dosing Regimen
For respiratory tract infections including pneumonia, the FDA-approved dose is 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours. 2 However, Augmentin should never be used as monotherapy for community-acquired pneumonia in elderly patients with comorbidities—it must be combined with either a macrolide (azithromycin or clarithromycin) or doxycycline to ensure atypical pathogen coverage. 1
The specific recommended combination regimen is:
- Augmentin 875 mg/125 mg twice daily PLUS azithromycin 500 mg on day 1, then 250 mg daily 1
- Alternative: Augmentin 875 mg/125 mg twice daily PLUS doxycycline 100 mg twice daily 1
- Treatment duration: 7 days in responding patients 1
Critical Renal Dosing Adjustments
Elderly patients are at high risk for impaired renal function, and Augmentin is primarily renally excreted, requiring mandatory dose adjustment. 2, 3
For severe renal impairment (GFR <30 mL/min):
- Reduce dose to 500 mg/125 mg every 12 hours or 250 mg/125 mg every 12 hours for less severe infections 2
- Do not use the 875 mg tablet in patients with creatinine clearance <30 mL/min 2
Key monitoring point: Serum creatinine alone is insufficient in elderly patients—calculate creatinine clearance using the Cockcroft-Gault formula, as elderly patients often have reduced renal function despite normal serum creatinine due to decreased lean body mass. 4, 3
Long-Term Care Specific Considerations
Long-term care residents have higher rates of multidrug-resistant organisms and polymicrobial infections compared to community-dwelling elderly. 5, 6 This makes empirical coverage broader in spectrum essential, supporting the combination therapy approach rather than monotherapy. 3, 6
Do not use Augmentin if the patient received it within the previous 3 months—select an alternative from a different antibiotic class to minimize resistance selection. 1
Administration and Tolerability
Administer Augmentin at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance. 2 This is particularly important in elderly patients who may have baseline gastrointestinal sensitivity.
For elderly patients with swallowing difficulties, the 125 mg/31.25 mg per 5 mL or 250 mg/62.5 mg per 5 mL suspension may be substituted for the 500 mg/125 mg tablet. 2
Critical Drug Interaction Warnings
If the patient is taking an ACE inhibitor or ARB, avoid concurrent trimethoprim-sulfamethoxazole due to hyperkalemia risk, but Augmentin remains safe. 7, 4
Avoid concurrent NSAIDs in elderly patients with any degree of renal impairment, as this dramatically increases nephrotoxicity risk. 4, 8
Common Pitfalls to Avoid
Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet—they contain different amounts of clavulanic acid and are not equivalent. 2
Monitor for diarrhea, which is significantly less common with twice-daily dosing compared to three-times-daily regimens. 2
Greater sensitivity in elderly patients cannot be ruled out, so monitor closely for adverse reactions, particularly in those ≥75 years. 2
Renal function monitoring is essential throughout therapy in elderly patients, as they are more likely to have decreased renal function that may worsen during treatment. 2, 3