What is the recommended intravenous dose of Augmentin (amoxicillin‑clavulanate) for adults with moderate and severe infections and for pediatric patients, and how should the dose be adjusted in renal impairment?

IV Augmentin Dosing Recommendations

For adults with moderate to severe infections, administer IV Augmentin 1.2 g (1000 mg amoxicillin/200 mg clavulanate) every 6-8 hours, and for pediatric patients, use 30 mg/kg every 6-8 hours (up to 200 mg/kg/day of the amoxicillin component for severe infections). 1

Adult Intravenous Dosing

Standard Dosing for Moderate to Severe Infections

• Administer 1.2 g (1000 mg/200 mg) IV every 6-8 hours for community-acquired intra-abdominal infections in non-critically ill, immunocompetent patients with adequate source control. 2
• The World Society of Emergency Surgery specifically recommends 2 g/0.2 g every 8 hours for intra-abdominal infections, representing a higher-dose regimen for more severe presentations. 2

Duration of Therapy

• For biliary infections with cholecystectomy, discontinue antimicrobial therapy within 24 hours unless there is evidence of infection outside the gallbladder wall. 1
• For intra-abdominal infections with adequate source control, treatment duration is typically 4-7 days based on clinical response. 1

Pediatric Intravenous Dosing

Standard Dosing by Weight

• Administer 30 mg/kg IV every 6-8 hours (based on the amoxicillin component) for most moderate infections in children. 1
• For severe infections or when undrained abscesses may be present, maximize β-lactam dosing up to 200 mg/kg/day of the amoxicillin component divided every 6 hours. 1

Age-Specific Considerations

• The Infectious Diseases Society of America recommends 30 mg/kg three times daily IV for all pediatric ages, with dose frequency increased to 4 times daily in severe infections for patients >3 months. 3
• For critically ill children, current dosing regimens may result in subtherapeutic concentrations due to augmented renal clearance, and four-hourly dosing of 25 mg/kg may be required. 4

Clinical Efficacy Data

• In pediatric studies using 100-200 mg/kg/day administered by short IV infusion in 3-4 divided doses, complete clinical cure or distinct improvement was achieved in all assessable cases with 92% bacteriological success. 5

Renal Impairment Dosing Adjustments

Adult Adjustments

• For creatinine clearance 10-30 mL/min: reduce frequency to every 12 hours or reduce dose by 50%. 1
• For creatinine clearance <10 mL/min: reduce frequency to every 24 hours or reduce dose by 75%. 1
• Hemodialysis patients require supplemental dosing after each dialysis session. 1

Pediatric Adjustments

• Apply similar proportional reductions based on estimated creatinine clearance, though specific pediatric renal dosing guidelines are limited. 1
• Monitor renal function closely in critically ill children, as 32% may experience augmented renal clearance requiring dose increases rather than reductions. 4

Critical Dosing Considerations

Augmented Renal Clearance in Critical Illness

• In critically ill children with sepsis, augmented renal clearance occurs in approximately 32% of patients, necessitating increased dosing frequency (every 4 hours) and consideration of 1-hour infusions rather than bolus dosing. 4
• Current published dosing regimens risk clinical failure in the early period of sepsis due to subtherapeutic concentrations. 4

Administration Technique

• Administer IV Augmentin by short infusion over 30-40 minutes to minimize venous irritation. 5
• For patients with augmented renal function, a 1-hour infusion is preferable to bolus dosing to maintain therapeutic concentrations. 4

Common Pitfalls to Avoid

• Do not underdose in critically ill patients or those with augmented renal clearance, as this leads to treatment failure rates up to 32%. 4
• Avoid using oral formulation dosing equivalents for IV therapy, as bioavailability and pharmacokinetics differ significantly. 5
• Do not extend dosing intervals beyond 8 hours in patients with normal renal function, as this results in subtherapeutic trough concentrations. 4

Monitoring Parameters

• Assess clinical response within 48-72 hours of initiating therapy. 2
• Monitor renal function, particularly in critically ill patients who may develop either renal insufficiency or augmented clearance. 4
• In patients with chronic renal insufficiency (GFR 55-70 mL/min), standard dosing is generally well tolerated without adjustment. 6