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Augmentin
amoxicillin/ clavulanate
Adult Dosing .
Dosage forms: TAB: 250 mg/125 mg, 500 mg/125 mg, 875 mg/125 mg; SUSP: 125 mg/31.25 mg per 5 mL, 250 mg/62.5 mg per 5 mL
infections, bacterial
- [500 mg/125 mg-875 mg/125 mg PO q12h]
- Alt: 250 mg/125 mg-500 mg/125 mg PO q8h; Info: give w/ food or milk
sinusitis, mild-moderate acute bacterial
- [<65 yo]
- Dose: 875 mg/125 mg PO q12h x5-7 days; Alt: 500 mg/125 mg PO q8h x5-7 days; Info: if severe infection or 65 yo and older, use high-dose regimen w/ ER tabs avail. as generic; give w/ food or milk
UTI, uncomplicated
- [500 mg/125 mg PO q12h x3-7 days]
- Info: not 1st-line agent; give w/ food or milk
pneumonia, community-acquired
- [500 mg/125 mg PO q8h for at least 5 days]
- Alt: 875 mg/125 mg PO q12h for at least 5 days; Info: part of multi-drug regimen; refer to IDSA guidelines; give w/ food or milk
febrile neutropenia, chemo-induced (off-label)
- [875 mg/125 mg PO q12h]
- Info: for empiric tx in low-risk pts; give w/ ciprofloxacin or levofloxacin; give w/ food or milk
diverticulitis (off-label)
- [875 mg/125 mg PO q8-12h x4-10 days]
- Info: refer to AGA guidelines; give w/ food or milk
renal dosing
- [see below]
- CrCl 10-30: 250 mg/125 mg-500 mg/125 mg q12h; CrCl <10: 250 mg/125 mg-500 mg/125 mg q24h; Info: do not use 875 mg/125 mg tab for CrCl <30
- HD: 250 mg/125 mg-500 mg/125 mg q24h, on dialysis days admin. after dialysis; consider supplement during and after dialysis if next maint. dose not due right after dialysis; PD: 250 mg/125 mg q12h; no supplement; Info: do not use 875 mg/125 mg tab
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised; amoxicillin/clavulanate-assoc. hepatic impairment hx: contraindicated
Peds Dosing .
- Dosage forms: TAB: 250 mg/125 mg, 500 mg/125 mg, 875 mg/125 mg; SUSP: 125 mg/31.25 mg per 5 mL, 250 mg/62.5 mg per 5 mL
Dosage Forms Discontinued in US
- [chewable tab, 200 mg/28.5 mg per 5 mL, 400 mg/57 mg per 5 mL susp not avail. as brand; see generic]
infections, bacterial
- [<3 mo]
- Dose: 30 mg/kg/day PO divided q12h; Info: use 125 mg/31.25 mg/5 mL susp; dose based on amoxicillin component; give w/ food or milk
- [3 mo and older, <40 kg]
- Dose: 25-45 mg/kg/day PO divided q12h, use 200 mg/28.5 mg or 400 mg/57 mg forms, avail. as generic; Alt: 20-40 mg/kg/day PO divided q8h, use 125 mg/31.25 mg per 5 mL or 250 mg/62.5 mg per 5 mL susp; Info: dose based on amoxicillin component; give w/ food or milk
- [3 mo and older, >40 kg]
- see Adult Dosing
otitis media, acute
- [3 mo-1 yo, <40 kg]
- Dose: 90 mg/kg/day PO divided q12h x10 days; Info: use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; dose based on amoxicillin component; give w/ food or milk
- [mild-moderate infection, 2-5 yo, <40 kg]
- Dose: 90 mg/kg/day PO divided q12h x7 days; Info: use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; dose based on amoxicillin component; give w/ food or milk
- [mild-moderate infection, 6-12 yo, <40 kg]
- Dose: 90 mg/kg/day PO divided q12h x5-7 days; Info: use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; dose based on amoxicillin component; give w/ food or milk
- [severe infection, 2-12 yo, <40 kg]
- Dose: 90 mg/kg/day PO divided q12h x10 days; Info: use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; dose based on amoxicillin component; give w/ food or milk
sinusitis, acute bacterial
- [3 mo-1 yo]
- Dose: 90 mg/kg/day PO divided q12h x10-14 days; Info: use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; dose based on amoxicillin component; give w/ food or milk
- [mild-moderate infection, 2 yo and older]
- Dose: 45 mg/kg/day PO divided q12h x10-14 days; Info: use 200 mg/28.5 mg or 400 mg/57 mg forms, avail. as generic; dose based on amoxicillin component; treat as severe infection in pts w/ daycare attendance, high risk of PCN-resistant S. pneumoniae, abx use w/in 1mo, recent hospitalization, or immunocompromised; give w/ food or milk
- [severe infection, 2 yo and older, <40 kg]
- Dose: 90 mg/kg/day PO divided q12h x10-14 days; Info: use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; dose based on amoxicillin component; give w/ food or milk
- [severe infection, 2 yo and older, >40 kg]
- Dose: 2000 mg/125 mg ER PO q12h x10-14 days; Info: use 1000 mg/62.5 mg ER tab, avail. as generic; give w/ food or milk
UTI
- [2 mo-2 yo]
- Dose: 20-40 mg/kg/day PO divided q8h x7-14 days; Info: dose based on amoxicillin component; if wt <40 kg, use 125 mg/31.25 mg per 5 mL or 250 mg/62.5 mg per 5 mL susp; duration varies w/ infection type, severity; give w/ food or milk
community-acquired pneumonia, mild-moderate bacterial
- [>3 mo, <40 kg (off-label)]
- Dose: 90 mg/kg/day PO divided q12h x5-10 days; Max: 4000 mg/day; Info: dose based on amoxicillin component; use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic; if wt >40 kg, give 2000 mg/125 mg ER PO q12h x7-10 days; use 1000 mg/62.5 mg ER tab, avail. as generic; give w/ food or milk
febrile neutropenia, chemo-induced (off-label)
- [45-90 mg/kg/day PO divided q12h]
- Info: for empiric tx in low-risk pts; give w/ ciprofloxacin; dose based on amoxicillin component; if 45 mg/kg/day regimen, use 200 mg/28.5 mg or 400 mg/57 mg forms, avail. as generic; if 90 mg/kg/day regimen and wt <40 kg, use 600 mg/42.9 mg per 5 mL susp, avail. as other brand or generic, max 2 g/dose; if 90 mg/kg/day regimen and wt >40 kg, give 2000 mg/125 mg ER PO q12h; use 1000 mg/62.5 mg ER tab, avail. as generic; give w/ food or milk
renal dosing
- [see below]
- CrCl 10-30: 8-20 mg/kg/dose q12h; CrCl <10: 8-20 mg/kg/dose q24h; Info: dose based on amoxicillin component; do not use 875 mg/125 mg tab if CrCl <30
- HD: 8-20 mg/kg/dose q24h, on dialysis days admin. after dialysis; consider supplement during and after dialysis if next maint. dose not due right after dialysis; PD: 8-20 mg/kg/dose q24h; no supplement; Info: dose based on amoxicillin component; do not use 875 mg/125 mg tab
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised; amoxicillin/clavulanate-assoc. hepatic impairment hx: contraindicated
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hepatic impairment hx, amoxicillin/clavulanate-associated
- cholestatic jaundice hx, amoxicillin/clavulanate-associated
- CrCl <30 (ER form)
- hemodialysis (ER form)
- mononucleosis
- caution: hypersensitivity to beta-lactams
- caution: asthma
- caution: asthma hx
- caution: ALL
- caution: HIV infection
- caution: abx-associated colitis hx, recent
- caution: seizure disorder
- caution: renal impairment
- caution: hepatic impairment
- caution: PKU (phenylalanine-containing form)
Drug Interactions .
Overview
amoxicillin
penicillin
- OAT3 substrate
- affected by altered gastrointestinal motility
- alters GI flora
- bactericidal activity requires bacterial growth
- binds to cation exchange resin/polymer
- impairs immunomodulatory bacterial infective agent
- lowers seizure threshold
clavulanate
beta-lactamase inhibitor
-
None
Avoid/Use Alternative
- aldesleukin
- amifampridine
- BCG live intravesical
- bremelanotide
- cholera vaccine, live
- fecal microbiota, live
- iohexol
- methotrexate
- typhoid vaccine, live
Monitor/Modify Tx
- bupropion
- digoxin
- exenatide
- iopamidol
- lixisenatide
- mycophenolate mofetil
- mycophenolic acid
- pramlintide
- sodium polystyrene sulfonate
- treosulfan
- warfarin
Therapeutic Advantage
- amikacin
- gentamicin
- probenecid
- streptomycin
- tobramycin
Caution Advised
- acetazolamide
- allopurinol
- brivaracetam
- busulfan
- cannabidiol
- carbamazepine
- cenobamate
- chlorambucil
- clobazam
- clomipramine
- clonazepam
- clorazepate
- clozapine
- demeclocycline
- diazepam
- doxycycline
- dulaglutide
- eravacycline
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fosphenytoin
- gabapentin
- ganaxolone
- hydroxychloroquine
- lacosamide
- lactulose
- lamotrigine
- levetiracetam
- lindane topical
- liraglutide
- lorazepam
- magnesium citrate
- methsuximide
- midazolam
- minocycline
- oxcarbazepine
- perampanel
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pregabalin
- primidone
- promethazine
- rufinamide
- sarecycline
- sodium picosulfate
- stiripentol
- sulfate bowel prep
- tetracycline
- tiagabine
- tirzepatide
- topiramate
- tramadol
- valproic acid
- vigabatrin
- zonisamide
Adverse Reactions .
Serious Reactions
- anaphylaxis
- hypersensitivity rxn, immediate or delayed
- serum sickness-like rxn
- erythema multiforme
- exfoliative dermatitis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- drug rxn w/ eosinophilia and systemic sx
- acute generalized exanthematous pustulosis
- linear IgA bullous dermatosis
- drug-induced enterocolitis syndrome
- C. difficile-assoc. diarrhea
- hemolytic anemia
- leukopenia
- thrombocytopenia
- agranulocytosis
- interstitial nephritis
- hepatitis
- cholestatic jaundice
- seizures
- aseptic meningitis
Common Reactions
- diarrhea
- nausea
- rash
- urticaria
- pruritus
- epigastric discomfort
- vomiting
- glossitis
- stomatitis
- black hairy tongue
- candidiasis, oral or vulvovaginal
- LFTs elevated
Safety/Monitoring .
Monitoring Parameters
Cr at baseline, then if prolonged tx cont. periodically; CBC, LFTs if prolonged tx
Look/Sound-Alike Drug Names
Augmentin confused with: amoxicillin; Amoxil; ampicillin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; possible risk of teratogenicity based on conflicting human data; no known risk of fetal harm based on animal data at 2x, 4x, and 9x MRHD
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm, though possible risk of infant diarrhea, rash, urticaria, thrush, and somnolence based on limited human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for amoxicillin: liver 10%; CYP450: unknown; for clavulanate: liver 50%; CYP450: unknown
Excretion: urine primarily (60-75% unchanged), bile; Half-life: 1h, 12h (severe renal impairment)
Subclass: Beta-Lactamase Inhibitors ; Beta-Lactams ; Penicillins, Aminopenicillins
Mechanism of Action
amoxicillin binds to peptidoglycan, inhibiting cell wall synthesis; clavulanate inhibits beta-lactamases, preventing beta-lactam degradation
Formulary .
No Formulary Selected
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