From the Guidelines
Yes, Augmentin (amoxicillin-clavulanate) can be given to people over 65, but dosing adjustments may be needed based on kidney function, which often declines with age. For older adults with normal kidney function, standard adult dosing typically applies: 500/125 mg or 875/125 mg twice daily, depending on infection severity 1. Treatment duration usually ranges from 7-14 days based on the type of infection. Older adults should be monitored more closely for side effects, particularly diarrhea (including C. difficile infection), which can be more severe in this age group.
Key Considerations
- Drug interactions are another concern, as many seniors take multiple medications.
- Augmentin works by combining amoxicillin, which kills bacteria by disrupting cell wall formation, with clavulanic acid, which prevents bacteria from inactivating the amoxicillin through beta-lactamase enzymes.
- This combination is effective against many common infections, including respiratory, urinary tract, and skin infections, making it a valuable antibiotic option for older adults when appropriately prescribed.
Renal Function Considerations
- Renal function decline is common in the elderly, with a 1% decline per year beyond age 30-40, resulting in a potential 40% decline by age 70 1.
- The pharmacokinetics and pharmacodynamics of renally excreted drugs, like Augmentin, are altered in patients with impaired renal function, necessitating potential dosage adjustments.
- Regular renal monitoring is warranted in elderly patients, especially those receiving renally cleared or nephrotoxic drugs 1.
From the FDA Drug Label
- 5 Geriatric Use Of the 3,119 patients in an analysis of clinical studies of amoxicillin and clavulanate potassium, 32% were ≥65 years old, and 14% were ≥75 years old No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out This drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Augmentin can be given to someone over 65, but care should be taken in dose selection and it may be useful to monitor renal function due to the potential for decreased renal function in elderly patients 2.
From the Research
Augmentin Use in Patients Over 65
- There is evidence to suggest that Augmentin (amoxicillin/clavulanate) can be used in patients over 65 years old, but with certain considerations 3.
- A study published in 1986 found that Augmentin was effective in treating urinary tract infections in elderly patients, with a response rate of 87.5% compared to 43% for amoxicillin alone 3.
- However, it is essential to consider the altered pharmacokinetics and pharmacodynamics of drugs in elderly patients due to co-morbid conditions and normal physiological changes associated with aging 4.
- Clinicians should be aware of the potential for drug-drug interactions and side effects, and individualized dose selection may be necessary, especially in patients with impaired renal and liver function 4.
Special Considerations
- Elderly patients may require reduced doses and longer dosing intervals due to decreased lean body weight and reduced renal function 5.
- The choice of antibiotics for serious infections in older patients should be broader in spectrum, and empirical therapy should be considered, especially for elderly long-term residents 5.
- Clinicians should understand the specific adverse effect profiles of antibiotics, including the potential for QT interval prolongation and tendon disorders, and take necessary precautions 6.