Augmentin Injection Dosing in Renal Impairment
For patients with normal renal function, administer Augmentin IV 1.2 g every 8 hours; for moderate renal impairment (GFR 10-30 mL/min), reduce to 600 mg every 12 hours; for severe impairment (GFR <10 mL/min), reduce to 600 mg every 24 hours, with an additional dose after hemodialysis if applicable. 1
Standard Dosing for Normal Renal Function
- Adults with normal renal function should receive 1.2 g IV (amoxicillin 1000 mg/clavulanate 200 mg) every 8 hours for prophylaxis or treatment of moderate infections 2
- For pediatric patients over 3 months, the recommended dose is 100-200 mg/kg/day divided into 3-4 doses administered by short IV infusion 3
- Neonates and infants ≤12 weeks require reduced dosing at 30 mg/kg/day divided every 12 hours due to immature renal function 1
Critical Dosing Adjustments for Renal Impairment
The FDA label provides explicit guidance that must be followed to prevent toxicity and maintain efficacy:
- Patients do not generally require dose reduction unless impairment is severe (GFR <30 mL/min) 1
- For GFR 10-30 mL/min: Administer 600 mg every 12 hours, adjusting based on infection severity 1
- For GFR <10 mL/min: Reduce to 600 mg every 24 hours 1
- Hemodialysis patients: Give 600 mg every 24 hours, with an additional dose both during and at the end of dialysis 1
Clinical Evidence Supporting Efficacy in Renal Impairment
- Augmentin demonstrated excellent efficacy in patients with chronic renal insufficiency (GFR 55-70 mL/min), achieving normalization of clinical and laboratory indices in 85.7% of urogenital infections when dosed at 375 mg orally three times daily 4
- The drug was well tolerated in patients with latent-stage chronic renal insufficiency without requiring dose adjustment for mild impairment 4
Common Pitfalls to Avoid
- Do not use the 875 mg tablet formulation in patients with GFR <30 mL/min, as this exceeds safe dosing limits 1
- Calculate actual GFR or creatinine clearance before dosing—do not rely on serum creatinine alone, particularly in elderly patients with reduced muscle mass who may have falsely reassuring creatinine values despite significant renal impairment 5
- Avoid underdosing in mild-moderate impairment (GFR 30-60 mL/min), as standard dosing can typically be maintained without adjustment 1
- Remember that pediatric dosing recommendations for renal impairment are not established—consult pediatric infectious disease specialists for children with significant renal dysfunction 1
Practical Administration Protocol
- Administer by short IV infusion over 30 minutes to minimize venous irritation 3
- Continue treatment for minimum 48-72 hours beyond clinical improvement or bacterial eradication 1
- For prophylactic use in abdominal surgery, a short-term regimen (1.2 g at induction, then 600 mg at 8 and 16 hours) is effective and superior to prolonged courses 2