ASK DIS: Augmentin Dosing: An Update

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IV Amoxycillin 1000mg/ Clavulanate 200mg (Augmentin)- 5:1
Tablet Amoxycillin 500mg/ Clavulanate 125mg (Augmentin) – 4:1
Syrup Amoxycillin 200mg/ Clavulanate 28mg in 5ml (Clamovid BID Granules) – 7:1

ORAL AUGMENTIN
Adult

mean AUC values for amoxicillin are essentially the same following BD dosing of AUGMENTIN 875/125 mg tablet (7:1) or TDS dosing of AUGMENTIN 500/125 mg tablet (4:1), in adults.
No differences between are seen when comparing the amoxicillin T1/2, or Cmax after normalisation for the different doses of amoxicillin administered.
Similarly, no differences are seen for the clavulanate T1/2, Cmax or AUC values after appropriate dose normalisation

Dosing Guide

Other type of infections are generally dosed at 625mg TDS (check specific indications before recommending)

Children

The clinical efficacy of AUGMENTIN DUO 400 (7:1 ratio) and AUGMENTIN FORTE (4:1 ratio) have been shown to be comparable in the approved indications, despite the differences in some pharmacokinetic parameters.

Oral Suspension Dosing	AUC (μg.h/mL)		Cmax (μg/mL)
Oral Suspension Dosing	Amoxycillin	Clavulanate	Amoxycillin	Clavulanate
AUGMENTIN 7:1 (45mg/kg/day) Given as BD	35.2	13.3	12.0	5.49
AUGMENTIN 4:1 (40mg/kg/day) Given as TDS	18.6	5.51	7.33	2.66

AUGMENTIN DUO (7:1) contains aspartame, and should be used with caution in patients with phenylketonuria.
In children with renal impairment, dosage should be adjusted according to degree of impairment using the alternative AUGMENTIN (4:1 ratio) 125mg/31.25mg or 250mg/62.5mg formulations.
AUGMENTIN DUO (7:1) formulation is not recommended for use in children with renal impairment.

Dosing
Neonates and infants aged < 12 weeks (3 months):

Due to incompletely developed renal function affecting elimination of amoxicillin in this age group, the recommended dose of AUGMENTIN is 30 mg/kg/day divided every 12 hours, based on the amoxicillin component.
Clavulanate elimination is unaltered in this age group.
Experience with the 200 mg/5 mL formulation in this age group is limited and, thus, use of the 125 mg/5 mL oral suspension is recommended.

Usual Dose	Augmentin 500/125mg (4:1) BD	Augmentin 250/125mg (2:1) TDS
Severe Infections	Augmentin 875/125mg (7:1) BD	Augmentin 500/125mg (4:1) TDS
	significantly fewer experienced severe diarrhea or withdrawals with diarrhea versus adults treated with 500 mg every 8 hours

Other Dosing Recomendations:

Other Affecting Factors

For clavulanate AUC and Cmax, the highest mean values and smallest inter-subject variabilities were achieved by administering AUGMENTIN at the start of a meal, compared to the fasting state or 30 or 150 minutes after the start of a meal.
Use the 7:1 formulation (ie, bid formulation) in higher doses to minimize GI tract effects

INTRAVENOUS AUGMENTIN
Intravenous Dosing

*Each 30mg AUGMENTIN provides 5mg clavulanic acid with 25mg amoxicillin.
Dosage for surgical prophylaxis:

procedures for less than 1 hour are : 1.2g at induction of anaesthesia.
Longer operations : subsequent doses of 1.2g (up to 4 doses in 24 hours)
this regime can be continued for several days if the procedure has significantly increased the risk of infection.

References:

ASK DIS