What is the recommended duration of Augmentin (amoxicillin‑clavulanate) treatment for the infection?

Duration of Augmentin Treatment

For most respiratory tract infections in adults and children, Augmentin (amoxicillin-clavulanate) should be administered for 7-14 days, with 10-14 days being standard for chronic rhinosinusitis and lower respiratory tract infections. 1

Treatment Duration by Infection Type

Chronic Rhinosinusitis (CRS)

• 14 days is the established duration for amoxicillin-clavulanate 875/125 mg twice daily in adults with CRS 1
• Multiple randomized trials consistently used 14-day courses with demonstrated clinical cure rates of 93% and bacteriologic eradication rates comparable to alternative antibiotics 1
• Shorter 9-day courses have been studied but showed lower clinical cure rates (51.2%) compared to the standard duration 1

Acute Bacterial Rhinosinusitis in Children

• 7-10 days is recommended for pediatric acute bacterial sinusitis 1, 2
• The French guidelines specify 7-10 days for children with maxillary sinusitis using amoxicillin-clavulanate 80 mg/kg/day 1
• Some sources suggest continuing until symptom-free for 7 days, typically resulting in 10-14 days total 2

Lower Respiratory Tract Infections

• 7-15 days depending on severity, with most patients requiring 10-14 days 3
• A 7-day course was effective in clinical trials for lower respiratory tract infections in adults, with 93-94% clinical success rates 3
• For more severe respiratory infections, the FDA label recommends using the 875/125 mg formulation every 12 hours 4

Acute Otitis Media in Children

• 10 days is the standard duration for children under 2 years with acute otitis media 2, 4
• The FDA label specifically studied and recommends 10 days for acute otitis media 4

Dosing Considerations That Affect Duration

Standard Adult Dosing

• 500/125 mg every 8 hours OR 875/125 mg every 12 hours for respiratory tract infections 4
• The every-12-hour regimen (875/125 mg) is equally effective as every-8-hour dosing (500/125 mg) and associated with less diarrhea 4, 3

High-Dose Pediatric Regimens

• 90 mg/kg/day (amoxicillin component) divided every 12 hours for severe infections or drug-resistant pathogens 2, 4
• This high-dose regimen typically requires the full 10-14 day duration for adequate bacterial eradication 2

When Shorter Courses May Be Appropriate

Pharmacokinetically Enhanced Formulations

• 5 days of amoxicillin-clavulanate 2000/125 mg twice daily (extended-release formulation) demonstrated equivalent efficacy to 7 days of standard formulation for acute exacerbations of chronic bronchitis 5
• This shorter duration achieved 93% clinical success and 76.7% bacteriologic success 5
• However, this extended-release formulation is distinct from standard Augmentin tablets 5

Uncomplicated Cases in Older Children

• 5-8 days may be sufficient for uncomplicated acute bacterial rhinosinusitis in children over 2 years without severe symptoms 2
• Some second-generation cephalosporins have shown efficacy with 5-day courses, suggesting shorter durations may be possible for selected cases 2

Critical Clinical Pitfalls to Avoid

Do Not Shorten Duration Prematurely

• Completing the full prescribed course is essential even if symptoms improve earlier, as bacteriologic eradication lags behind clinical improvement 1
• Clinical relapse rates were significantly higher (8% vs 0%) when inadequate treatment duration was used 1

Do Not Extend Beyond Necessary Duration

• Avoid prolonging treatment beyond 14 days for standard respiratory infections, as this increases adverse effects (particularly diarrhea) without additional benefit 1, 3
• The exception is documented infections requiring longer courses based on specific pathogen identification 1

Reassess at 48-72 Hours

• Evaluate clinical response within 2-3 days of initiating therapy 2, 6
• If fever persists or recurs on day 5 of treatment, this represents treatment failure requiring antibiotic change, not duration extension 7
• Consider switching to alternative antibiotics rather than simply extending the same failing regimen 7

Special Populations Requiring Longer Duration

• Immunocompromised patients may require the full 14-day course regardless of infection severity 2
• Children under 2 years should receive 10-day courses for otitis media due to higher relapse rates with shorter durations 2, 4
• Patients with recent antibiotic exposure (within 4-6 weeks) warrant 10-14 day courses due to increased resistance risk 2

Renal Impairment Adjustments

• Patients with GFR <30 mL/min should not receive the 875/125 mg dose 4
• GFR 10-30 mL/min: Use 500/125 mg or 250/125 mg every 12 hours for the full treatment duration 4
• GFR <10 mL/min or hemodialysis: Use 500/125 mg or 250/125 mg every 24 hours, with additional dose during and after dialysis 4