What is the appropriate Augmentin (amoxicillin‑clavulanate) dosing for a 7‑day course in an adult patient with no penicillin allergy and normal renal function?

Augmentin Dosing for a 7-Day Course in Adults

For an adult with normal renal function and no penicillin allergy, prescribe Augmentin 875 mg/125 mg twice daily for 7 days for most respiratory tract infections, or escalate to 2000 mg/125 mg twice daily for 7 days if risk factors for antibiotic resistance are present. 1, 2

Standard Dosing Regimen

• The FDA-approved standard adult dose is 875 mg/125 mg twice daily or 500 mg/125 mg three times daily 3
• For respiratory tract infections and more severe infections, the 875 mg/125 mg twice-daily formulation is preferred 3
• A 7-day course is clinically equivalent to 10 days for most respiratory infections, with similar success rates and fewer adverse events 1, 4

High-Dose Regimen Indications

Escalate to 2000 mg/125 mg twice daily for 7 days if any of the following risk factors are present: 1, 2

• Antibiotic use within the past month
• Close contact with healthcare workers or healthcare environments
• Previous antibiotic treatment failure
• Smoker or household exposure to smoking
• High community prevalence of resistant bacteria (>10% penicillin-resistant S. pneumoniae)
• Age >65 years
• Comorbid conditions (diabetes, chronic cardiac/hepatic/renal disease)
• Immunocompromised status
• Moderate to severe infection severity
• Frontal or sphenoidal sinusitis
• History of recurrent infections

Administration Guidelines

• Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance 3
• The high-dose 2000 mg/125 mg formulation extends therapeutic amoxicillin levels over the 12-hour dosing interval to eradicate organisms with MICs up to 4-8 mg/L 2, 4

Duration Considerations by Infection Type

• Acute bacterial rhinosinusitis (ABRS): 5-7 days is as effective as 10 days 1, 2
• Community-acquired pneumonia: 7-10 days 2
• Acute exacerbations of chronic bronchitis: 5-7 days 4
• Urinary tract infections: 3-7 days 2

Clinical Efficacy Data

• High-dose amoxicillin-clavulanate (2000 mg/125 mg twice daily) achieves 90-92% predicted clinical efficacy versus 83-88% for standard dosing when resistance risk factors are present 1, 2
• A 5-day course of 2000 mg/125 mg twice daily demonstrated equivalent clinical success (93.0%) to a 7-day course of 875 mg/125 mg twice daily (91.2%) in acute exacerbations of chronic bronchitis 4

Common Pitfalls to Avoid

• Do not substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet – they contain different amounts of clavulanate and are not equivalent 3
• Do not use standard-dose amoxicillin-clavulanate when risk factors for resistance are present – treatment failure rates reach 20-25% in these scenarios 2
• Reassess at 48-72 hours – if no clinical improvement occurs, consider changing antibiotics or reevaluating the diagnosis 2
• Adverse events (primarily gastrointestinal) occur in 15-40% of patients but rarely require treatment discontinuation 1

Renal Function Monitoring

• Although you specified normal renal function, reassess renal function periodically during treatment, especially in elderly patients who may have decreased renal function despite normal serum creatinine 5