Augmentin Dosing with eGFR 30 mL/min/1.73 m²
For patients with an eGFR of 30 mL/min/1.73 m², Augmentin (amoxicillin/clavulanate) requires dose reduction or interval extension to prevent drug accumulation and toxicity.
Renal Dosing Principles at eGFR 30
At eGFR 30 mL/min/1.73 m², patients are classified as CKD stage G4 (severely reduced kidney function), which mandates careful medication dosing adjustments for renally cleared drugs 1.
The KDIGO guidelines strongly recommend that prescribers account for GFR when dosing medications, particularly for drugs with significant renal clearance 2.
Amoxicillin and clavulanate are both primarily eliminated by the kidneys, making dose adjustment essential at this level of renal function 3.
Specific Dosing Recommendations
Standard dosing regimens must be modified as follows:
For eGFR 10-30 mL/min/1.73 m²: Reduce the dose to 250-500 mg every 12 hours, or use standard doses (500-875 mg) every 24 hours depending on infection severity 3.
For serious infections: Consider 500 mg every 12 hours rather than the standard every 8-hour regimen to maintain efficacy while preventing accumulation 3.
Avoid extended-release formulations (Augmentin XR) in patients with eGFR <30 mL/min/1.73 m², as these are contraindicated due to unpredictable absorption and clearance 3.
Clinical Monitoring Requirements
Monitor renal function closely during treatment, as acute changes can necessitate further dose adjustments 1, 2.
Assess for signs of drug accumulation: Watch for neurological symptoms (confusion, seizures with high doses), gastrointestinal disturbances, and hepatotoxicity, which may indicate excessive drug levels 3.
Check potassium and electrolytes if the patient is on concurrent RAAS inhibitors or other nephrotoxic agents, as these combinations increase risk at reduced GFR 1, 2.
Important Clinical Caveats
Temporarily discontinue during acute illness: If the patient develops intercurrent illness, dehydration, or requires contrast administration, hold Augmentin until renal function stabilizes 2.
Post-dialysis dosing: For patients on hemodialysis (eGFR <15 or dialysis-dependent), administer a supplemental dose after each dialysis session, as both amoxicillin and clavulanate are dialyzable 3.
Avoid nephrotoxic combinations: Do not combine with NSAIDs, aminoglycosides, or other nephrotoxic agents when eGFR is ≤30 mL/min/1.73 m², as this significantly increases the risk of acute kidney injury 1, 2.
Practical Dosing Algorithm
- Confirm eGFR is stable at 30 mL/min/1.73 m² (not acutely declining) 2.
- For mild-to-moderate infections: Use 250-500 mg every 12 hours 3.
- For severe infections: Use 500 mg every 12 hours (maximum dose at this eGFR) 3.
- Recheck renal function within 2-3 days of starting therapy and weekly thereafter 2.
- If eGFR drops below 10 mL/min/1.73 m²: Extend interval to every 24 hours or consider alternative antibiotics 3.
Evidence Quality Note
The dosing recommendations are based on pharmacokinetic principles for renally cleared drugs 3 and general renal dosing guidelines 1, 2, as specific high-quality trials for Augmentin at eGFR 30 are limited. One older study demonstrated safety in patients with GFR 55-70 mL/min but did not address eGFR 30 specifically 4. Therefore, conservative dosing based on established renal adjustment principles is the safest approach 3.