What is the management for a lactating female with a nasal furuncle, prescribed Augmentin (amoxicillin/clavulanate)?

From the Guidelines

This patient requires prompt treatment with Augmentin (amoxicillin-clavulanate) 875/125 mg twice daily for 7-10 days to prevent serious complications from the nasal furuncle, as it provides good coverage against Staphylococcus aureus, the most common causative organism, and is safe during breastfeeding 1. The patient's symptoms, including fever, headache, and failed self-treatment with warm compresses and ice, indicate a need for antibiotic therapy. The recent history of GI illness with nasal drainage and campfire exposure may have contributed to the development of the nasal furuncle.

• The physical exam confirms the presence of a developing nasal furuncle, which is consistent with the patient's symptoms.
• The use of Augmentin is supported by the Infectious Diseases Society of America (IDSA) guidelines, which recommend the use of antibiotics active against Staphylococcus aureus for the treatment of skin and soft tissue infections, including furuncles 1.
• In addition to antibiotics, warm compresses should be applied to the area 3-4 times daily for 10-15 minutes to help with localization and drainage of the infection.
• The patient should be monitored closely for signs of spreading infection, including increased pain, redness extending beyond the nose, fever above 101°F, eye swelling, vision changes, or severe headache, which would warrant immediate medical attention.
• A follow-up appointment in 48-72 hours is essential to ensure the infection is responding to treatment. The dangerous triangle of the face (area between the corners of the mouth and bridge of the nose) requires aggressive treatment because infections here can potentially spread to the cavernous sinus through valveless veins, leading to serious intracranial complications.
• The IDSA guidelines recommend incision and drainage for large furuncles, but this patient's condition does not currently require this level of intervention 1.
• The patient's lactation status is not a contraindication for the use of Augmentin, as it is considered safe during breastfeeding 1.

From the FDA Drug Label

Patients should be aware that amoxicillin and clavulanate potassium tablets contain a penicillin class drug product that can cause allergic reactions in some individuals. The patient is taking amoxicillin-clavulanate for a nasal furuncle.

• The drug label does not provide information on the treatment of nasal furuncles.
• However, it does mention that amoxicillin and clavulanate potassium tablets should only be used to treat bacterial infections.
• The patient should be counseled to take the medication exactly as directed and to complete the full course of therapy to decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance 2.
• The label also warns of possible allergic reactions and diarrhea as a common problem caused by antibacterials.

From the Research

Patient Treatment and Management

• The patient is being treated with Augmentin for a nasal furuncle, which is consistent with coverage for Staphylococcus aureus 3.
• The medication has been confirmed to be safe during breastfeeding.
• The patient has been advised to return in 48-72 hours for reassessment or sooner if symptoms worsen.
• Warm compresses have been recommended as adjunctive therapy.

Staphylococcus aureus Infections and Treatment

• Staphylococcus aureus can cause various types of infections, including impetigo, which is a common bacterial skin infection in children 4.
• Treatment options for Staphylococcus aureus infections include topical antibiotics, such as mupirocin, retapamulin, and fusidic acid, as well as oral antibiotics like amoxicillin/clavulanate 4, 3.
• The efficacy of amoxycillin/clavulanate in treating severe Staphylococcus aureus infections has been demonstrated in both experimental and clinical settings 3.
• However, the increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, requires careful consideration of treatment options 4, 5.

Antibiotic Resistance and Susceptibility

• The antimicrobial susceptibility profiles of Staphylococcus aureus isolates can vary, with some studies showing high resistance rates to certain antibiotics, such as doxycycline and amoxicillin 5.
• In vitro studies have demonstrated the effectiveness of clavulanic acid in protecting against beta-lactamase degradation of penicillin and amoxycillin 6.
• The use of amoxycillin-clavulanic acid has been shown to be effective against Staphylococcus aureus isolates with a wide distribution of beta-lactamase production 6.