From the Guidelines
For both ear infections and foot cellulitis, a broad-spectrum antibiotic like amoxicillin-clavulanate (Augmentin) would be an appropriate choice, as it covers the common bacteria that cause both conditions, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in ear infections, and Streptococcus and Staphylococcus species in cellulitis 1. The typical adult dose is 875/125 mg taken twice daily for 5 days, but treatment should be extended if the infection has not improved within this time period 1. This medication works well because it covers the common bacteria that cause both conditions. Alternatives include cephalexin (Keflex) 500 mg four times daily, or clindamycin 300-450 mg four times daily if penicillin allergy is present. Some key points to consider when treating cellulitis include:
- Elevation of the affected foot
- Treatment of predisposing factors, such as edema or underlying cutaneous disorders 1
- Careful examination of the interdigital toe spaces to treat fissuring, scaling, or maceration, which may eradicate colonization with pathogens and reduce the incidence of recurrent infection 1 It's essential to take the full course of antibiotics even if symptoms improve quickly. Medical evaluation is necessary before starting any antibiotic treatment, as the specific causative bacteria and severity of infection will determine the most appropriate antibiotic choice and whether oral therapy is sufficient or if intravenous treatment is needed.
From the FDA Drug Label
14.2 Acute Bacterial Otitis Media and Diarrhea in Pediatric Patients One U.S./Canadian clinical trial was conducted which compared 45/6. 4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media.
INDICATIONS AND USAGE Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Anaerobes: Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess; serious skin and soft tissue infections; septicemia; intra- abdominal infections such as peritonitis and intra-abdominal abscess
Antibiotic Coverage:
- Ear Infection: Amoxicillin-clavulanate (2) is effective against acute bacterial otitis media.
- Cellulitis of Foot: Clindamycin (3) is indicated for serious skin and soft tissue infections, which includes cellulitis. Recommended Antibiotic:
- Based on the provided information, amoxicillin-clavulanate (2) can be used to cover ear infections, and clindamycin (3) can be used to cover cellulitis of the foot. However, it is essential to note that the most appropriate antibiotic should be chosen based on the specific causative organisms and their susceptibility to the antibiotic.
From the Research
Antibiotic Treatment for Ear Infection and Cellulitis of Foot
- The treatment of ear infections, such as acute otitis media (AOM), often involves the use of antibiotics like amoxicillin, with or without clavulanate 4, 5, 6, 7.
- For cellulitis of the foot, the choice of antibiotic may depend on the suspected causative pathogens, but amoxicillin-clavulanate is often considered a suitable option due to its broad-spectrum activity.
- A study comparing once or twice daily doses of amoxicillin, with or without clavulanate, found that these regimens were comparable in effectiveness for the treatment of AOM 4.
- Another study found that twice-daily trimethoprim-sulfamethoxazole was more effective than twice-daily amoxicillin-clavulanate for the treatment of AOM, with fewer side effects 5.
- A comparison of a single dose of ceftriaxone with a 10-day course of amoxicillin-clavulanate for AOM found that the two regimens had similar efficacy, but with differences in nasopharyngeal flora and resistance patterns 6.
- A systematic review of antimicrobial agents for AOM in children found that amoxicillin-clavulanate was often superior or comparable to other options, including azithromycin, cefdinir, and penicillin V 7.
Considerations for Antibiotic Choice
- The choice of antibiotic should be guided by factors such as the suspected causative pathogens, local resistance patterns, and patient factors like allergy history and renal function.
- Amoxicillin-clavulanate is often considered a first-line option for AOM and may also be suitable for cellulitis of the foot, but other antibiotics like ceftriaxone or trimethoprim-sulfamethoxazole may be considered in certain cases 4, 5, 6, 7.